Towne J B, Hussey C V, Bandyk D F
Department of Vascular Surgery, Medical College of Wisconsin, Milwaukee.
J Vasc Surg. 1988 May;7(5):661-6. doi: 10.1067/mva.1988.avs0070661.
Abnormalities of the fibrinolytic system can result in unusual or unexplained clotting that occurs spontaneously or after minor trauma. We identified five patients with limb-threatening arterial thrombosis of the upper extremity associated with either a low level of plasminogen or an abnormal immunoreactive plasminogen. All patients had extensive thrombosis of the brachial, radial, and ulnar arteries. Two patients had concomitant thrombus of the subclavian artery, which in one patient was associated with distal embolization to the hand. There was no evidence of atherosclerosis in any patient. Detection of an abnormal plasminogen level was done by immunoelectrophoresis of the patient's serum with antiplasminogen sera. In these patients a separate immunoreactive band located near the anode and distinct from the normal single plasminogen band was detected. Because of extensive thrombosis of the arterial system, exploration of the brachial artery, as well as the origin of all the forearm vessels, was necessary for complete balloon catheter thrombectomy. Prompt diagnosis and treatment are necessary to prevent the catastrophic complication of arm or hand amputation. Patients with an abnormal plasminogen level should receive perioperative heparin therapy and long-term warfarin to prevent recurrent thrombotic episodes.
纤维蛋白溶解系统异常可导致自发或轻微创伤后出现异常或不明原因的凝血。我们确定了5例上肢危及肢体的动脉血栓形成患者，这些患者伴有纤溶酶原水平低下或免疫反应性纤溶酶原异常。所有患者均有肱动脉、桡动脉和尺动脉广泛血栓形成。2例患者伴有锁骨下动脉血栓形成，其中1例患者伴有手部远端栓塞。所有患者均无动脉粥样硬化证据。通过用抗纤溶酶原血清对患者血清进行免疫电泳来检测纤溶酶原水平异常。在这些患者中，检测到一条位于阳极附近且与正常单一纤溶酶原条带不同的独立免疫反应条带。由于动脉系统广泛血栓形成，为了进行完全的球囊导管血栓切除术，有必要探查肱动脉以及所有前臂血管的起始部位。为防止手臂或手部截肢这一灾难性并发症，必须迅速诊断并治疗。纤溶酶原水平异常的患者应接受围手术期肝素治疗和长期华法林治疗，以预防血栓形成复发。
