McNamara T O, Bomberger R A, Merchant R F
University of Nevada, Medical School, Washoe Medical Center, Reno.
Circulation. 1991 Feb;83(2 Suppl):I106-19.
Acute ischemia of the lower limb remains a significant risk to both life and limb. Mortality rates of approximately 10-30% and amputation rates of the same magnitude in the survivors are repeatedly reported despite advances in medical and surgical techniques. Our experience, which utilized percutaneous intra-arterial thrombolysis as the initial treatment in 72 instances (63 patients), has resulted in a markedly lower mortality rate of 1.6% and a lower amputation rate of 8.5% in the survivors. Careful categorization by clinical degree of ischemia indicates that 82% of the cases were either threatened or irreversible limb ischemia. The initial treatment with thrombolysis did not preclude subsequent prompt surgical treatment when necessary; in these cases, thrombolysis promoted improved surgical results (100%) when it was successful. It markedly reduced the need for urgent surgery, usually simplified the subsequent surgical approach, diminished the overall need for surgery, and often accomplished a successful outcome alone (31%). Significant bleeding was not noted during subsequent surgical procedures and was noted in only 2.8% of the cases. Confirmation of these results and further improvements in technique might justify the use of an initially high-dose urokinase transcatheter infusion regimen as the initial treatment of choice for acute lower-limb ischemia.
下肢急性缺血仍然对生命和肢体构成重大风险。尽管医学和外科技术取得了进步，但仍反复报道死亡率约为10 - 30%，幸存者的截肢率也在同一水平。我们的经验是，在72例（63名患者）中采用经皮动脉内溶栓作为初始治疗方法，结果导致死亡率显著降低至1.6%，幸存者的截肢率降低至8.5%。根据缺血的临床程度进行仔细分类表明，82%的病例为肢体缺血受到威胁或不可逆转。溶栓的初始治疗并不排除在必要时随后进行及时的手术治疗；在这些病例中，溶栓成功时可促进手术效果改善（100%）。它显著减少了紧急手术的需求，通常简化了后续手术方法，减少了总体手术需求，并且常常单独取得成功结果（31%）。在后续手术过程中未发现明显出血，仅2.8%的病例出现出血情况。对这些结果的确认以及技术的进一步改进可能证明，使用初始高剂量尿激酶经导管输注方案作为急性下肢缺血的初始治疗选择是合理的。
