Stanek Frantisek, Ouhrabkova Radoslava, Prochazka David
Department of Cardiology, Third Faculty of Medicine, Charles University, Prague, Czech Republic -
Department of Radiology, District Hospital Kladno, Kladno, Czech Republic -
Minerva Cardioangiol. 2019 Jun;67(3):234-245. doi: 10.23736/S0026-4725.18.04770-9. Epub 2018 Aug 28.
Acute limb ischemia is a vascular emergency defined as a sudden decrease in limb perfusion associated with a risk of loss of viability of the affected extremity. Surgical treatment (Fogarty thromboembolectomy) is indicated only in suprainguinal occlusions. Other cases of acute and subacute limb ischemia should be managed percutaneously. Catheter-based treatment involves local thrombolysis and percutaneous mechanical thrombectomy (PMT). There are several devices in use for PMT; of them, the Rotarex system appears to be the most useful. There are no randomized studies comparing thrombolysis and PMT. Only indirect comparison is possible. The immediate and long-term results of PMT using the Rotarex device are probably more favorable than those following thrombolysis. Particularly for older and polymorbid patients, it may be significant that PMT, in comparison with thrombolysis, can restore blood flow faster and in one session; no contraindications for PMT in contrast to potentially life-threatening complications in thrombolysis exist, and there is also no need for observation in intensive care unit after PMT. Hospital stay after PMT is shorter. There is only one exception when thrombolysis cannot be replaced by Rotarex PMT - in the case of crural arteries involvement - due to the catheter size. In our opinion, PMT is superior to thrombolysis in the treatment of acute and subacute limb ischemia. Thrombolysis should be considered only in special cases, e.g. in crural arteries occlusions or in failure of mechanical thrombectomy.
急性肢体缺血是一种血管急症，定义为肢体灌注突然减少，并伴有受影响肢体丧失生存能力的风险。手术治疗（Fogarty血栓切除术）仅适用于腹股沟上动脉闭塞。急性和亚急性肢体缺血的其他病例应采用经皮治疗。基于导管的治疗包括局部溶栓和经皮机械血栓切除术（PMT）。有几种设备用于PMT；其中，Rotarex系统似乎是最有用的。目前尚无比较溶栓和PMT的随机研究。只能进行间接比较。使用Rotarex设备进行PMT的近期和长期结果可能比溶栓治疗更有利。特别是对于老年和多病患者，与溶栓相比，PMT能更快且一次性恢复血流，这一点可能很重要；与溶栓治疗可能危及生命的并发症相比，PMT不存在禁忌证，而且PMT后也无需在重症监护病房观察。PMT后的住院时间更短。只有一种情况Rotarex PMT不能替代溶栓治疗，即当累及小腿动脉时，原因是导管尺寸问题。我们认为，在急性和亚急性肢体缺血的治疗中，PMT优于溶栓治疗。溶栓治疗仅应在特殊情况下考虑，例如小腿动脉闭塞或机械血栓切除术失败时。
