Tavri Sidhartha, Ganguli Suvranu, Bryan Roy G, Goverman Jeremy, Liu Raymond, Irani Zubin, Walker T Gregory
Division of Vascular and Interventional Radiology, Department of Radiology, University Hospitals and Case Western Reserve University School of Medicine, 11100 Euclid Avenue, BSH 5056, Cleveland, OH 44106.
Division of Interventional Radiology, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
J Vasc Interv Radiol. 2016 Aug;27(8):1228-35. doi: 10.1016/j.jvir.2016.04.027. Epub 2016 Jun 28.
To evaluate intraarterial catheter-directed thrombolysis for prediction and prevention of delayed surgical amputation as part of multidisciplinary management of frostbite injury.
A retrospective review was performed of 13 patients (11 men, 2 women; median age, 33.4 y; range, 8-62 y) at risk of tissue loss secondary to frostbite injury and treated with catheter-directed tissue plasminogen activator (t-PA) thrombolysis. Amputation data were assessed on follow-up (mean, 23 mo; range, 9-83 mo). Angiographic findings were classified into complete, partial, and no angiographic response and assessed for association with follow-up amputation rates. Correlation between amputation outcome and duration of cold exposure (mean, 23 h; range, 5-96 h), time between exposure and rewarming therapy (mean, 25.5 h; range, 7-95 h), and time between exposure and t-PA thrombolysis (mean, 32 h; range, 12-96 h) was assessed. Complications were recorded.
Of 127 digits at risk on baseline angiography that were treated with catheter-directed thrombolysis, complete recovery was seen in 106 (83.4%). Total mean t-PA dose per extremity was 27.5 mg (range, 12-48 mg) over a mean period of 34 hours (range, 12-72 h). Patients with complete angiographic response (8 patients; 79.5% of digits) did not require amputations; 4 of 5 patients (80%) with partial angiographic response (20.5% of digits) underwent amputation (P = .007). There was no significant correlation between amputation rates and duration of cold exposure (P = .9), time to rewarming therapy (P = .88), and time to thrombolysis (P = .56). Femoral access site bleeding in 2 patients was managed conservatively. One patient underwent surgical exploration for brachial artery hematoma.
Intraarterial catheter-directed thrombolysis should be included in initial management of frostbite injury, as it may prevent delayed amputations. The degree of angiographic response to thrombolysis can potentially predict amputation outcomes.
评估动脉内导管定向溶栓在冻伤损伤多学科管理中对预测和预防延迟性手术截肢的作用。
对13例因冻伤有组织丢失风险且接受导管定向组织型纤溶酶原激活剂（t-PA）溶栓治疗的患者（11例男性，2例女性；中位年龄33.4岁；范围8 - 62岁）进行回顾性研究。在随访（平均23个月；范围9 - 83个月）时评估截肢数据。血管造影结果分为完全、部分和无血管造影反应，并评估其与随访截肢率的相关性。评估截肢结果与冷暴露持续时间（平均23小时；范围5 - 96小时）、暴露与复温治疗之间的时间（平均25.5小时；范围7 - 95小时）以及暴露与t-PA溶栓之间的时间（平均32小时；范围12 - 96小时）之间的相关性。记录并发症情况。
在基线血管造影时有截肢风险且接受导管定向溶栓治疗的127个手指中，106个（83.4%）完全恢复。每个肢体t-PA的总平均剂量为27.5毫克（范围12 - 48毫克），平均持续时间为34小时（范围12 - 72小时）。血管造影完全反应的患者（8例；占手指的79.5%）无需截肢；血管造影部分反应的5例患者中有4例（80%）（占手指的20.5%）接受了截肢（P = .007）。截肢率与冷暴露持续时间（P = .9）、复温治疗时间（P = .88）和溶栓时间（P = .56）之间无显著相关性。2例患者股动脉穿刺部位出血经保守治疗。1例患者因肱动脉血肿接受了手术探查。
动脉内导管定向溶栓应纳入冻伤损伤的初始治疗，因为它可能预防延迟性截肢。溶栓的血管造影反应程度可能预测截肢结果。
Zotero 插件