Perler B A, White R I, Ernst C B, Williams G M
J Vasc Surg. 1985 Nov;2(6):799-805. doi: 10.1067/mva.1985.avs0020799.
Despite the growing enthusiasm for low-dose intra-arterial thrombolytic therapy, the efficacy and risks in specific clinical situations have not been defined. During the past 13 months, 10 infrainguinal bypass graft occlusions occurred in nine patients 2 to 48 months postoperatively and were treated with local infusions of either streptokinase or urokinase. The grafts treated included two saphenous vein femoropopliteal grafts, two expanded polytetrafluoroethylene (PTFE) femoropopliteal grafts, four saphenous vein femoro-anterior tibial grafts, one saphenous vein-PTFE composite femoro-anterior tibial graft, and one saphenous vein-PTFE composite femoroperoneal graft. The graft occlusions occurred 2 to 14 days prior to initiation of treatment. The infusion failed to restore flow completely in seven grafts; and of the three successes, two patients required surgical treatment of complications. All successful recanalizations occurred within 48 hours of the initiation of thrombolytic therapy. Of the seven failures, two patients had viable limbs and were discharged, whereas two required amputation (one above and one below knee). Three patients underwent surgical thrombectomy and revisions that were successful in two and resulted in a below-knee amputation in the other. Despite all precautions, complications occurred in five patients. Low-dose intra-arterial thrombolytic therapy is a poorly efficacious, risky method of infrainguinal graft occlusion management.
尽管对低剂量动脉内溶栓治疗的热情日益高涨，但特定临床情况下的疗效和风险尚未明确。在过去的13个月中，9例患者在术后2至48个月发生了10次股腘以下旁路移植血管闭塞，并接受了链激酶或尿激酶的局部输注治疗。接受治疗的移植物包括两条大隐静脉股腘动脉移植血管、两条膨体聚四氟乙烯（PTFE）股腘动脉移植血管、四条大隐静脉股胫前动脉移植血管、一条大隐静脉-PTFE复合股胫前动脉移植血管和一条大隐静脉-PTFE复合股腓动脉移植血管。移植血管闭塞发生在开始治疗前2至14天。7条移植血管的灌注未能完全恢复血流；在3例成功的病例中，有2例患者需要对并发症进行手术治疗。所有成功的再通均发生在溶栓治疗开始后的48小时内。在7例失败的病例中，2例患者肢体存活并出院，而2例需要截肢（1例膝上截肢，1例膝下截肢）。3例患者接受了手术取栓和修复，其中2例成功，另1例导致膝下截肢。尽管采取了所有预防措施，仍有5例患者出现了并发症。低剂量动脉内溶栓治疗是一种治疗股腘以下移植血管闭塞疗效不佳且风险较高的方法。
