Wolfson R H, Kumpe D A, Rutherford R B
Arch Surg. 1984 Jun;119(6):697-702. doi: 10.1001/archsurg.1984.01390180059010.
We treated 27 cases of arterial thromboembolism, including nine thrombosed grafts, with intra-arterial (IA) streptokinase. Complete lysis without significant residual lesions was achieved in eight (30%) of the cases, and partial lysis with sustained improvement was achieved in an additional six cases (22%). Partial lysis revealing inaccessible residual disease in runoff vessels occurred in four (15%) of the cases, and nine (33%) were primary failures. Surgery was completely avoided in 11 (41%) of the patients, lesser amputations were possible in three (11%), and 18 (67%) avoided major amputation. Grafts lysed faster (35 v 62 hours) and more frequently (seven [78%] of nine v 11 [61%] of 18) than native vessels, but had a higher rethrombosis rate (four [71%] of seven v two [11%] of 11) and a lower late patency rate (two [22%] of nine v nine [50%] of 18). Significant bleeding occurred in one (3.7%) of the patients, and major thromboembolic complications occurred in four (13.8%). None occurred in those treated with concomitant heparin sodium. Better patency and fewer complications were also observed in limbs that were not acutely threatened, when IA streptokinase infusion was completed within 48 hours, and when the occluded segment and runoff vessels were rendered widely patent by IA streptokinase, with the aid of balloon angioplasty when necessary (five [36%] of 14).
我们采用动脉内（IA）链激酶治疗了27例动脉血栓栓塞病例，其中包括9例移植血管血栓形成。8例（30%）病例实现了完全溶解且无明显残留病变，另有6例（22%）实现了部分溶解并持续改善。4例（15%）病例出现部分溶解，显示流出道血管存在无法处理的残留病变，9例（33%）为原发性失败。11例（41%）患者完全避免了手术，3例（11%）患者可行较小截肢手术，18例（67%）患者避免了大截肢手术。与自体血管相比，移植血管溶解更快（35小时对62小时）且更频繁（9例中的7例[78%]对18例中的11例[61%]），但再血栓形成率更高（7例中的4例[71%]对11例中的2例[11%]），晚期通畅率更低（9例中的2例[22%]对18例中的9例[50%]）。1例（3.7%）患者发生严重出血，4例（13.8%）发生重大血栓栓塞并发症。在同时使用肝素钠治疗的患者中未发生此类情况。在未受到急性威胁的肢体中，当IA链激酶输注在48小时内完成时，以及当IA链激酶在必要时借助球囊血管成形术使闭塞段和流出道血管广泛通畅时，也观察到了更好的通畅率和更少的并发症（14例中的5例[36%]）。
