Norem R F, Short D H, Kerstein M D
Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
Surg Gynecol Obstet. 1988 Aug;167(2):87-91.
Nineteen patients with acute onset of ischemia affecting the lower extremities were studied from January 1985 to March 1987. Patients with preoperative Doppler and angiographic studies consistent with arterial occlusions subsequently underwent a thromboembolectomy using a Fogarty catheter. All patients were given a bolus injection of 5,000 units of heparin intravenously at the start of the surgical procedure. In all patients studied, a clot was retrieved on the first pass, but after two additional passes, total distal blood flow was not shown to be restored on angiogram. Intraoperative angiograms showed distal emboli. All patients underwent intraoperative fibrinolytic therapy by local bolus infusion. Streptokinase, ranging from 50,000 to 200,000 units, was administered in 50,000 unit injections in ten to 15 minute intervals. Repeat attempts at thromboembolectomy with the Fogarty catheter resulted in an additional clot retrieved in all 19 patients with intraoperative angiographic, Doppler and clinical improvement. No perioperative or postoperative complications were observed, including anaphylactic reactions, uncontrollable bleeding or amputation. Four patients had nonacute femoropopliteal bypass operations within the next six months. Intraoperative fibrinolytic therapy can be a safe and effective adjunct in acute arterial embolic occlusion requiring balloon catheter thromboembolectomy.
1985年1月至1987年3月，对19例急性下肢缺血患者进行了研究。术前多普勒和血管造影检查结果与动脉闭塞相符的患者随后使用Fogarty导管进行了血栓切除术。所有患者在手术开始时静脉注射5000单位肝素。在所有研究的患者中，首次通过时均取出了血栓，但在另外两次通过后，血管造影显示远端血流未恢复。术中血管造影显示有远端栓子。所有患者均通过局部推注进行术中溶栓治疗。链激酶用量为50000至200000单位，以50000单位的剂量每隔10至15分钟注射一次。再次使用Fogarty导管进行血栓切除术，结果在所有19例患者中均又取出了一块血栓，术中血管造影、多普勒检查及临床症状均有改善。未观察到围手术期或术后并发症，包括过敏反应、无法控制的出血或截肢。4例患者在接下来的6个月内进行了非急性股腘动脉搭桥手术。术中溶栓治疗可作为急性动脉栓塞性闭塞需要球囊导管血栓切除术时一种安全有效的辅助治疗方法。
