Grip O, Wanhainen A, Acosta S, Björck M
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Eur J Vasc Endovasc Surg. 2017 Jun;53(6):853-861. doi: 10.1016/j.ejvs.2017.02.003. Epub 2017 Mar 11.
The purpose was to study long-term outcome after thrombolysis for acute arterial lower limb ischaemia, and to evaluate the results depending on the underlying aetiology of arterial occlusion.
This was a retrospective study of patients entered into a prospective database. Patients were identified in prospective databases from two vascular centres, including a large number of variables. Case records were analysed retrospectively. Through cross linkage with the Population Registry 100% accurate survival data were obtained. Between January 2001 and December 2013, 689 procedures were included. The aetiology of ischaemia was graft/stent/stent graft occlusion in 39.8%, arterial thrombosis in 27.7%, embolus in 25.1% and popliteal aneurysm in 7.4%.
The mean follow-up was 59.4 months (95% CI, 56.1-62.7), during which 32.9% needed further re-interventions, 16.4% underwent amputation without re-intervention, and 50.7% had no re-intervention. The need for re-intervention during follow-up was 48.0% in the graft/stent occlusions group, 34.0% of the popliteal aneurysm group, 25.4% in the thrombosis group, and 16.3% in the embolus group (p < .001). The overall primary patency rates were 69.1% and 55.9% at 1 and 5 years, respectively. Primary patency at 5 years was higher for the embolus group (83.3%, p = .002) and lower for the occluded graft/stent group (43.3%, p < .001). Secondary patency rates were 80.1% and 75.2% at 1 and 5 years, respectively, without difference between the subgroups. The amputation rate was lower in the embolic group at 1 and 5 years (8.1% and 11.1%, respectively, p = .001). Survival was higher in the group with occluded popliteal aneurysms at 5 years (83.3%, p = 0.004). Amputation free survival was 72.1% and 45.2% at 1 and 5 years; lower in the occluded graft/stent group at five years (37.9%, p = .007).
Intra-arterial thrombolytic therapy achieves good medium and long-term clinical outcome, reducing the need of open surgical treatment in most patients.
本研究旨在探讨急性下肢动脉缺血溶栓治疗的长期疗效，并根据动脉闭塞的潜在病因评估治疗结果。
这是一项对纳入前瞻性数据库的患者进行的回顾性研究。从两个血管中心的前瞻性数据库中识别患者，数据库包含大量变量。对病例记录进行回顾性分析。通过与人口登记处交叉链接，获得了100%准确的生存数据。2001年1月至2013年12月期间，共纳入689例手术。缺血病因包括移植物/支架/覆膜支架闭塞占39.8%，动脉血栓形成占27.7%，栓子占25.1%，腘动脉瘤占7.4%。
平均随访时间为59.4个月（95%可信区间，56.1 - 62.7），在此期间，32.9%的患者需要进一步再次干预，16.4%的患者未经再次干预接受了截肢手术，50.7%的患者未进行再次干预。随访期间再次干预的需求在移植物/支架闭塞组为48.0%，腘动脉瘤组为34.0%，血栓形成组为25.4%，栓子组为16.3%（p <.001）。总体1年和5年的原发性通畅率分别为69.1%和55.9%。栓子组5年的原发性通畅率较高（83.3%，p =.002），闭塞移植物/支架组较低（43.3%，p <.001）。继发性通畅率1年和5年分别为80.1%和75.2%，各亚组之间无差异。栓塞组1年和5年的截肢率较低（分别为8.1%和11.1%，p =.001）。腘动脉瘤闭塞组5年的生存率较高（83.3%，p = 0.004）。无截肢生存率1年和5年分别为72.1%和45.2%；闭塞移植物/支架组5年时较低（37.9%，p =.007）。
动脉内溶栓治疗取得了良好的中长期临床疗效，减少了大多数患者进行开放手术治疗的需求。
