Chalmers R T, Hoballah J J, Kresowik T F, Synn A Y, Nakagawa N, Sharp W J, Corson J D
Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242-1086, USA.
Cardiovasc Surg. 1995 Jun;3(3):293-7. doi: 10.1016/0967-2109(95)93879-t.
The outcome of 72 direct intra-arterial urokinase infusions was studied prospectively. Thirty four were performed for native arterial occlusion and 38 for bypass graft occlusion; the immediate success rates were 67.5 and 84% respectively. The overall incidence of complications was 26%. Median follow-up was 36 (range 1-60) months. Seventeen patients (27%) died during follow-up; nine (14%) required a major amputation. Among patients with native arterial occlusion, 29% had no adjunctive procedure after thrombolysis; of these patients, 85% remained patent at a median of 21 (range 3-42) months. Among bypass occluded patients, only two (6%) had no lesion revealed after successful lysis; both bypasses remain patent at 54 and 58 months respectively. For patients treated with balloon angioplasty immediately after successful thrombolysis, 62% with native arterial occlusion remained patent at a median of 39 (range 2-60) months, whereas only 27% of bypass occlusion patients were patent at a median of 11 (range 2-40) months. Of patients requiring a surgical procedure after thrombolysis, 23 new bypasses (15 vein, eight prosthetic) were placed (nine in native arterial occlusion patients, 14 in bypass occlusion patients). In addition, there were 15 other surgical procedures, including six thrombectomies, four vein patch angioplasties, four vein jump grafts and one endarterectomy. The primary and secondary patencies for the 15 new vein bypasses placed were 81 and 88% respectively at a median follow-up of 36 months. Good immediate results were experienced with urokinase thrombolysis for peripheral arterial and graft occlusions. However, multiple adjunctive procedures were required to maintain patency.(ABSTRACT TRUNCATED AT 250 WORDS)
对72例直接动脉内输注尿激酶的结果进行了前瞻性研究。34例用于原发性动脉闭塞，38例用于旁路移植闭塞；即刻成功率分别为67.5%和84%。并发症的总发生率为26%。中位随访时间为36（1 - 60）个月。17例患者（27%）在随访期间死亡；9例（14%）需要进行大截肢。在原发性动脉闭塞患者中，29%在溶栓后未进行辅助手术；在这些患者中，85%在中位时间21（3 - 42）个月时仍保持通畅。在旁路闭塞患者中，成功溶栓后只有2例（6%）未发现病变；两条旁路分别在54和58个月时仍保持通畅。对于成功溶栓后立即接受球囊血管成形术治疗的患者，原发性动脉闭塞患者中有62%在中位时间39（2 - 60）个月时仍保持通畅，而旁路闭塞患者中只有27%在中位时间11（2 - 40）个月时保持通畅。在溶栓后需要进行外科手术的患者中，放置了新旁路23条（15条静脉，8条人工血管）（9条用于原发性动脉闭塞患者，14条用于旁路闭塞患者）。此外，还进行了15项其他外科手术，包括六个血栓切除术、四个静脉补片血管成形术、四个静脉搭桥移植术和一个内膜切除术。在中位随访36个月时，新放置的15条静脉旁路的一期和二期通畅率分别为81%和88%。尿激酶溶栓治疗外周动脉和移植血管闭塞取得了良好的即刻效果。然而，需要多次辅助手术来维持通畅。（摘要截短至250字）
