Vohra R, Lieberman D P
Peripheral Vascular Unit, Royal Infirmary, Glasgow, UK.
J R Coll Surg Edinb. 1991 Apr;36(2):83-5.
A review of 46 episodes of arterial emboli to the arm in 44 patients is presented. Two-thirds of cases were of cardiac origin whereas subclavian artery abnormality was responsible for 14%. Thirty-six per cent had axillary occlusion, 52% had a brachial lesion, and the lesion was distal to the elbow in 11%. Of the 36 patients treated surgically, 33 retained a viable arm with a palpable radial pulse in 26. Of the ten patients with 'failed first embolectomy', six technical failures were revised successfully, retaining a viable hand in all of them. The other four failures had evidence of organized intraluminal thrombus; one had been induced by anti-thrombin III deficiency. Three of this latter group lost limbs. Because delay leads to irreversible ischaemic changes, there seems to be an understandable bias in favour of early surgical exploration in equivocal cases.
本文对44例患者的46次手臂动脉栓塞事件进行了回顾。三分之二的病例起源于心脏，而锁骨下动脉异常占14%。36%的患者有腋动脉闭塞，52%有肱动脉病变，11%的病变位于肘部远端。在接受手术治疗的36例患者中，33例保留了有活力的手臂，其中26例可触及桡动脉搏动。在10例“首次取栓失败”的患者中，6例技术失败经成功修正，所有患者均保留了有活力的手部。其他4例失败患者有腔内机化血栓的证据；其中1例由抗凝血酶III缺乏引起。后一组中的3例患者肢体丧失。由于延误可导致不可逆的缺血性改变，因此在可疑病例中倾向于早期手术探查似乎是可以理解的。
