Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, 7-1 Funabashi, Wadanaka-cho, Fukui, 918-8503, Japan.
Jpn J Radiol. 2012 Feb;30(2):180-4. doi: 10.1007/s11604-011-0022-y. Epub 2011 Dec 22.
To report technical aspects of thrombolysis and thromboaspiration for acute thromboembolic occlusion in the upper extremity.
This study included four consecutive patients with acute thromboembolic occlusion in the upper extremity (right arm, n = 3; left arm n = 1). The mean patient age was 81.3 ± 11.5 years (mean ± standard deviation; range 69-92 years) and all patients had chronic atrial fibrillation. Emergent angiography was performed via the femoral artery.
Thromboembolic occlusion was demonstrated in the axillary artery (n = 2), axillary and radial arteries (n = 1), and brachial, radial, and ulnar arteries (n = 1). Endovascular treatment was performed via the unaffected brachial (n = 3) or radial artery (n = 1). Thrombolysis was performed for three patients using 360,000-480,000 IU (mean 400,000 ± 69,000 IU) urokinase, including 12-h continuous infusion in one. Thromboaspiration was performed in all four patients using a 6F catheter. Recanalization was achieved in all patients and all arms were salvaged. Perforation of the small branch during guidewire manipulation was successfully managed by placement of a microcoil.
The combination of thrombolysis and thromboaspiration is effective for acute thromboembolic occlusion in the upper extremity.
报告上肢急性血栓栓塞闭塞性溶栓和血栓抽吸的技术方面。
本研究纳入了 4 例上肢急性血栓栓塞性闭塞患者（右上肢 3 例，左上肢 1 例）。患者平均年龄为 81.3 ± 11.5 岁（均数 ± 标准差；范围 69-92 岁），均患有慢性心房颤动。经股动脉行紧急血管造影。
腋动脉（n = 2）、腋动脉和桡动脉（n = 1）和肱动脉、桡动脉和尺动脉（n = 1）均存在血栓栓塞性闭塞。通过未受累的肱动脉（n = 3）或桡动脉（n = 1）进行血管内治疗。3 例患者采用 360,000-480,000 IU（均数 400,000 ± 69,000 IU）尿激酶进行溶栓，其中 1 例进行了 12 小时连续输注。4 例患者均采用 6F 导管进行血栓抽吸。所有患者均实现再通，所有上肢均得以保留。在导丝操作过程中小分支穿孔，通过放置微线圈成功进行了处理。
溶栓和血栓抽吸联合应用对上肢急性血栓栓塞闭塞有效。
