Wholey Michael H, Palacios Raul G, Mendez-Castillo Alejandro, Pounds Lori C
Cardiovascular and Interventional Radiology and Vascular Surgery, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA -
Audie L. Murphy Veterans Hospital San Antonio, San Antonio, TX, USA -
J Cardiovasc Surg (Torino). 2018 Dec;59(6):804-809. doi: 10.23736/S0021-9509.17.09938-4. Epub 2017 Jul 26.
It is imperative to gain safe access into the occluded targeted vessel and begin treating acute extremity limb ischemia. Often the origin of the targeted native artery or bypass graft will have a flush occlusion making it difficult to cannulate. This paper looks at the novel use of portable ultrasound to evaluate the origin of the artery or bypass graft to help facilitate the start of thrombolysis.
We reviewed our last 2 years of acute limb ischemia in our patients with high risk factors and comorbidities. We reviewed the use of ultrasound in these cases from the initial use of gaining femoral access to real time ultrasound and fluoroscopic guidance into the targeted native artery or bypass graft to begin needed thrombolysis.
We had 26 acute limb ischemia in 10 patients with native arterial circulation and in 16 patients with either saphenous or prosthetic bypass grafts. Ultrasound was used in gaining safe access with no complications in 22 contralateral and 2 antegrade femoral and 4 direct-graft accesses. Ultrasound was used in 6 of these cases to help gain access in the occluded graft (4 cases) and saphenous veins (2 cases). It was successful in all cases but one case which had bleeding.
Ultrasound is increasing in its application including acute limb ischemia with flush occlusions of native arteries and bypass grafts.
必须安全进入闭塞的目标血管并开始治疗急性肢体缺血。通常，目标天然动脉或旁路移植物的起始部位会出现平齐闭塞，导致插管困难。本文探讨便携式超声在评估动脉或旁路移植物起始部位以帮助促进溶栓治疗开始方面的新用途。
我们回顾了过去两年中患有高危因素和合并症的患者的急性肢体缺血情况。我们回顾了这些病例中超声的使用情况，从最初获取股动脉通路到实时超声和透视引导进入目标天然动脉或旁路移植物以开始所需的溶栓治疗。
我们有26例急性肢体缺血患者，其中10例为天然动脉循环，16例为大隐静脉或人工旁路移植物。超声用于安全通路建立，22例对侧、2例顺行股动脉和4例直接移植物通路均无并发症。在其中6例病例中，超声用于帮助进入闭塞的移植物（4例）和大隐静脉（2例）。除1例出血病例外，所有病例均成功。
超声的应用正在增加，包括在天然动脉和旁路移植物平齐闭塞的急性肢体缺血中。
