Department of Vascular and Endovascular Surgery, Faculty of Medicine, Tanta University, El Geish Street, Tanta, 31527, Egypt.
Cardiovasc Interv Ther. 2021 Oct;36(4):498-505. doi: 10.1007/s12928-020-00702-1. Epub 2020 Sep 7.
Management of acute limb ischemia (ALI) due to occlusions in popliteal and infrapopliteal arteries remains a challenge. Open surgical methods and even the novel percutaneous mechanical thrombectomy devices have not shown satisfactory results in these small arteries. The aim of this prospective study was to assess the safety and efficacy of catheter-directed thrombolysis (CDT) in this type of ALI with distal occlusion. Between April 2017 and June 2019, 22 patients with ALI secondary to popliteal or infrapopliteal occlusion were enrolled in the study. Patients with thrombosis, embolism, and thrombosed bypass graft were included; all belong to category I or IIa of Rutherford's classification. Technical success, limb salvage, complications, and mortality were evaluated at short- and long-term follow-up. Technical success was achieved in 81.8%, while 36.4% of patients needed additional balloon angioplasty, major amputation in 13.6%, minor bleeding in 18.2%, and no major hemorrhage. Limb salvage at 30 days and 1 year was 86.4% and 72.7%, respectively. At 1 year, primary patency was 63.6% and mortality was 9.1%. Catheter directed thrombolysis is a safe and highly effective treatment modality for popliteal or infrapopliteal acute limb ischemia unless contraindicated.
由于腘动脉和腘下动脉阻塞导致的急性肢体缺血（ALI）的管理仍然是一个挑战。开放性手术方法，甚至是新型经皮机械血栓切除术装置，在这些小动脉中都没有显示出令人满意的结果。本前瞻性研究的目的是评估导管定向溶栓（CDT）在这种伴有远端阻塞的 ALI 中的安全性和有效性。在 2017 年 4 月至 2019 年 6 月期间，共有 22 例因腘动脉或腘下动脉阻塞导致 ALI 的患者入组研究。纳入的患者包括血栓形成、栓塞和血栓形成的旁路移植；所有患者均属于 Rutherford 分类的 I 类或 IIa 类。在短期和长期随访中评估技术成功率、肢体存活率、并发症和死亡率。技术成功率为 81.8%，而 36.4%的患者需要额外的球囊血管成形术，13.6%的患者需要截肢，18.2%的患者有轻微出血，无大出血。30 天和 1 年的肢体存活率分别为 86.4%和 72.7%。1 年时，原发性通畅率为 63.6%，死亡率为 9.1%。除非有禁忌证，否则导管定向溶栓是治疗腘动脉或腘下动脉急性肢体缺血的一种安全且非常有效的治疗方法。
