Manojlović Vladimir, Popović Vladan, Nikolić Dragan, Milosević Dorde, Pasternak Janko, Kaćanski Milos
Department for Vascular Surgery, Clinical Centre of Vojvodina, Novi Sad.
Med Pregl. 2013 Jan-Feb;66(1-2):41-5. doi: 10.2298/mpns1302041m.
Acute critical lower limb ischemia refers to the state of severely impaired vitality of lower limbs due to acute occlusion of arterial blood vessel by a thrombus or emboli. Surgical revascularization in the first 6-12 hours after the onset of symptoms gives the best results. However, a high mortality rate and probability of limb loss make this problem more debatable, and can be related with associated diseases.
This research included 95 patients who had been operated within the first 12 hours after the onset of symptoms of critical limb ischemia We collected the following data: age and sex of patients, etiology of limb ischemia, type of operation, associated diseases and outcome of treatment.
Most of the patients were 70 to 80 years old, both sexes being equally represented. There was significantly more arterial embolism (70%) than thrombosis on the prior arterial lesion. Most of the embolizations were treated with Fogarty balloon catheter embolectomy (98%); however, a great number ofarterial thrombosis demanded more complex "inflow" and "outflow" ensuring procedures such as thromboendarterectomy and bypass (33%). The performed surgical procedures showed no statistical differences when final outcome was analyzed. Amputation had to be performed in about 3% of the patients and all of them were diabetics. Mortality rate in this research was 10.5% and 7/10 with this outcome had severe form of chronic myocardiopathy and metabolic decompensation.
Acute critical lower limb ischemia should be treated surgically as soon as possible. Negative outcomes are associated with comorbidity and general condition of the patient.
急性严重下肢缺血是指由于血栓或栓子导致动脉血管急性闭塞，从而使下肢活力严重受损的状态。症状出现后的最初6 - 12小时内进行手术血管重建效果最佳。然而，高死亡率和肢体丧失的可能性使这个问题更具争议性，并且可能与相关疾病有关。
本研究纳入了95例在严重肢体缺血症状出现后的前12小时内接受手术的患者。我们收集了以下数据：患者的年龄和性别、肢体缺血的病因、手术类型、相关疾病以及治疗结果。
大多数患者年龄在70至80岁之间，男女比例均等。先前动脉病变中动脉栓塞（70%）明显多于血栓形成。大多数栓塞采用Fogarty球囊导管取栓术治疗（98%）；然而，大量动脉血栓需要更复杂的“流入”和“流出”保障手术，如血栓内膜切除术和旁路手术（33%）。分析最终结果时，所实施的手术程序无统计学差异。约3%的患者不得不接受截肢手术，且所有这些患者均为糖尿病患者。本研究中的死亡率为10.5%，7/10有此结果的患者患有严重形式的慢性心肌病和代谢失代偿。
急性严重下肢缺血应尽快进行手术治疗。不良结果与患者的合并症和一般状况有关。
