Stenzinger W, van de Loo J
Medizinische Klinik und Poliklinik, Innere Medizin A, Westfälische Wilhelms-Universität, Münster.
Z Kardiol. 1993;82 Suppl 5:71-7.
Acute ischemia in peripheral arterial occlusive disease due to progressive atherosclerosis is most commonly caused by thrombotic or thromboembolic events. Such a condition is a threat to both the limb and the life of a patient which requires rapid therapeutic decisions based on close cooperation between vascular surgeons, angiologists and radiologists. In complete ischemia with sensomotoric deficit and in suprainguinal occlusions surgical management remains the treatment of choice. Patients with incomplete ischemia and infrainguinal occlusions and patients unfit for major vascular surgery are appropriate candidates for local thrombolysis and percutaneous revascularization procedures. Available data on the main thrombolytic agents fail to show convincing difference between these drugs with regard to their efficacy and safety. Full heparinization is recommended before any definite therapy, after thrombolysis and if necessary after percutaneous transluminal angioplasty (PTA). Antiplatelet drugs should be given before and after reconstructive surgery and PTA and following heparinization after thrombolysis and PTA. In all conditions long-term treatment with antiplatelet drugs is recommended.
由于进行性动脉粥样硬化导致的外周动脉闭塞性疾病中的急性缺血，最常见的原因是血栓形成或血栓栓塞事件。这种情况对患者的肢体和生命都是一种威胁，需要血管外科医生、血管病学家和放射科医生密切合作，迅速做出治疗决策。在伴有感觉运动功能障碍的完全缺血以及腹股沟上闭塞的情况下，手术治疗仍然是首选治疗方法。缺血不完全且病变位于腹股沟下的患者以及不适合进行大型血管手术的患者，是局部溶栓和经皮血管再通术的合适人选。关于主要溶栓药物的现有数据未能显示出这些药物在疗效和安全性方面有令人信服的差异。在进行任何确定性治疗之前、溶栓后以及必要时在经皮腔内血管成形术（PTA）后，建议进行充分的肝素化。在重建手术和PTA前后以及溶栓和PTA后肝素化后，均应给予抗血小板药物。在所有情况下，均建议使用抗血小板药物进行长期治疗。
