Li Xiaodong, Wang Pei, Yu Changyu, Yan Xiaowei, Yin Jing
Department of Hand and Foot Surgery, Chengde Medical College Affiliated Hospital, Chengde Hebei, 067000, P.R.China.
Department of Hand and Foot Surgery, Chengde Medical College Affiliated Hospital, Chengde Hebei, 067000,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Oct 15;31(10):1220-1224. doi: 10.7507/1002-1892.201705057.
To explore the effectiveness of arterial crisis after replantation of limb treated by ultrasound guided Fogarty balloon catheter.
Between January 2012 and July 2016, 27 patients suffered from arterial crisis after replantation of limb were treated with ultrasound guided Fogarty balloon catheter combined with thrombolytic anticoagulant. There were 18 males and 9 females with the age of 19-51 years (mean, 32 years). The limb mutilation position was at knee joint in 3 cases, lower limb in 9 cases, ankle joint in 6 cases, elbow joint in 2 cases, forearm in 4 cases, and wrist joint in 3 cases. The arterial crisis happened at 2.5-18 hours (mean, 7.5 hours) after limb replantation surgery. Color doppler ultrasonography was used to diagnose the arterial thrombosis, finally the anastomotic thrombosis were found in 16 cases, non-anastomotic thrombosis in 7 cases, and combined thrombosis in 4 cases. All the thrombosis were deteced in the arteries with the length of 0.8-3.9 cm.
No complication such as vascular perforation, rupture, air embolism, thromboembolism, wound infection, or sepsis happened after operation. Arterial crisis occurred again in 3 cases at 1.5-13.5 hours after limb replantation and treated by arterial exploration, 1 case was treated successfully; 2 cases had arterial occlusion and partial necrosis of limb, and got amputation treatment at last. The rest 24 cases survived with the incision healing by first stage. In the 24 cases, 1 case suffered from acute myonephropathic metabolic syndrome and corrected after hemodialysis; 1 case suffered from acute liver functional damage and corrected by comprehensive treatment of internal medicine. The 24 patients were followed up 7-38 months (mean, 11 months). At last follow-up, blood supply of the limb was good with normal skin temperature and improved sense of feeling, activity, and swelling. According to Chinese Medical Association of hand surgery to the upper extremity function assessment standard, the results were excellent in 12 cases, good in 8 cases, and fair in 4 cases with an excellent and good rate of 83.3%.
Ultrasound guided Fogarty balloon catheter treatment of posterior replantation of arterial crisis can accurately locate the thrombosis, get the thrombus fast and invasive minimally to avoid the blind and repeated thrombectomy, and obtain certain effectiveness.
探讨超声引导下Fogarty球囊导管治疗肢体再植术后动脉危象的疗效。
2012年1月至2016年7月，对27例肢体再植术后发生动脉危象的患者采用超声引导下Fogarty球囊导管联合溶栓抗凝治疗。其中男18例，女9例，年龄19～51岁，平均32岁。肢体离断部位：膝关节3例，下肢9例，踝关节6例，肘关节2例，前臂4例，腕关节3例。动脉危象发生在肢体再植术后2.5～18小时，平均7.5小时。采用彩色多普勒超声诊断动脉血栓形成，最终发现吻合口血栓形成16例，非吻合口血栓形成7例，混合性血栓形成4例。所有血栓均位于长度为0.8～3.9 cm的动脉内。
术后未发生血管穿孔、破裂、空气栓塞、血栓栓塞、伤口感染或脓毒症等并发症。3例患者在肢体再植术后1.5～13.5小时再次发生动脉危象，行动脉探查术，1例治疗成功；2例动脉闭塞，肢体部分坏死，最终行截肢治疗。其余24例患者一期愈合存活。24例中，1例发生急性肌病性代谢综合征，经血液透析后纠正；1例发生急性肝功能损害，经内科综合治疗后纠正。24例患者随访7～38个月，平均11个月。末次随访时，肢体血供良好，皮温正常，感觉、活动及肿胀情况改善。按中华医学会手外科学会上肢功能评定标准，结果优12例，良8例，可4例，优良率为83.3%。
超声引导下Fogarty球囊导管治疗肢体再植术后动脉危象，能准确定位血栓，快速取栓且创伤极小，避免盲目反复取栓，取得了一定疗效。
