Van Damme H, Boesmans E, Defraigne J O
Service de Chirurgie Cardiovasculaire, CHU Sart Tilman, Liège, Belgique.
Service de Chirurgie Cardiovasculaire, CHU Sart Tilman, Liège, Belgique..
Rev Med Liege. 2018 May;73(5-6):304-311.
Despite major advances in the contemporary management of peripheral arterial occlusive disease, acute ischemia of the lower limb is still characterized by an important morbidity, limb threat, and mortality, and continues to pose a challenge to the vascular surgeon. Ageing of the population increases the prevalence of acute lower limb ischemia. The two principal etiologies of acute ischemia of the lower limbs are arterial embolism and in situ thrombosis of an atherosclerotic artery or of a bypass graft. Popliteal aneurysm thrombosis and vascular trauma are less common causes of severe limb ischemia. Prompt recognition and treatment of acute limb ischemia in an urgent setting are crucial, in order to shorten as much as possible the duration of the ischemia. This paper highlights diagnostic work-up (staging of the severity of ischemia) and appropriate management of acute ischemia of the lower limb. Different procedures of revascularization (operative clot removal, catheter-directed thrombolysis, bypass grafting are evaluated and their outcome results are compared.
尽管在当代外周动脉闭塞性疾病的治疗方面取得了重大进展，但下肢急性缺血仍具有较高的发病率、肢体威胁和死亡率，仍然给血管外科医生带来挑战。人口老龄化增加了急性下肢缺血的患病率。下肢急性缺血的两个主要病因是动脉栓塞以及动脉粥样硬化动脉或旁路移植血管的原位血栓形成。腘动脉瘤血栓形成和血管创伤是导致严重肢体缺血的较不常见原因。在紧急情况下迅速识别和治疗急性肢体缺血至关重要，以便尽可能缩短缺血持续时间。本文重点介绍了急性下肢缺血的诊断检查（缺血严重程度分期）和适当治疗。对不同的血管重建手术（手术取栓、导管定向溶栓、旁路移植术）进行了评估，并比较了它们的结果。
