Ouriel K
Department of Surgery, University of Rochester Medical Center, NY 14642-8410, USA.
Curr Opin Gen Surg. 1994:257-64.
The standard treatment of peripheral arterial occlusion has been operative, employing embolectomy, thrombectomy, or bypass grafting to restore blood flow to the compromised extremity. Intra-arterial thrombolysis has been advocated as an initial intervention designed to unmask the anatomic lesion responsible for the occlusive event, with a directed or endovascular modality thereafter. Four thrombolytic agents are in clinical use: streptokinase, urokinase, recombinant tissue plasminogen activator, and acylated plasminogen streptokinase activator complex. The agents differ with respect to efficacy of thrombolysis, fibrin specificity, and cost. At present, urokinase is the most widely used. Recent randomized clinical trials suggest a benefit of thrombolytic therapy in the initial management of acute peripheral arterial occlusion, with improved patient survival and similar amputation rates compared with immediate open intervention. Each modality has its place in specific patient subcategories; the determination of which patients are best served by a specific modality awaits the results of large clinical trials.
外周动脉闭塞的标准治疗方法一直是手术治疗，采用栓子切除术、血栓切除术或旁路移植术来恢复患肢的血流。动脉内溶栓已被提倡作为一种初始干预措施，旨在揭示导致闭塞事件的解剖病变，随后采用定向或血管内治疗方式。有四种溶栓药物正在临床使用：链激酶、尿激酶、重组组织型纤溶酶原激活剂和酰化纤溶酶原链激酶激活剂复合物。这些药物在溶栓效果、纤维蛋白特异性和成本方面存在差异。目前，尿激酶是使用最广泛的。最近的随机临床试验表明，溶栓治疗在急性外周动脉闭塞的初始治疗中具有益处，与立即进行开放干预相比，患者生存率提高，截肢率相似。每种治疗方式在特定患者亚组中都有其适用之处；确定哪种治疗方式最适合特定患者群体有待大型临床试验的结果。
