Pilger E, Decrinis M, Stark G, Koch G, Obernosterer A, Tischler R, Lafer M, Doder A
Department of Internal Medicine, Karl-Franzens-University, Graz, Austria.
Ann Intern Med. 1994 Jan 1;120(1):40-4. doi: 10.7326/0003-4819-120-1-199401010-00007.
To evaluate nonsurgical alternatives in reopening chronically occluded aortic bifurcation.
Uncontrolled randomized study.
University-affiliated referral center for vascular diseases.
Twenty-five of 39 consecutive patients with chronic aortoiliac disease including a totally occluded aortic bifurcation were found to be acceptable candidates for an aortobifemoral prosthetic graft.
Patients were randomly assigned to receive either streptokinase or urokinase or recombinant tissue-type plasminogen activator (rt-PA). In cases of successful thrombolysis and residual obstructions, subsequent balloon angioplasty was attempted. Prosthetic bypass grafting was done if thrombolytic treatment and balloon angioplasty failed.
Complete lysis was achieved in 5 of 25 patients (20%). In 10 (40%) patients, lysis showed residual obstructions, which were reopened mechanically in 8 patients; 2 patients had extra-anatomical bypass grafts. Ten patients (40%) without thrombolysis had surgical aortobifemoral bypass grafts. Overall, recanalization and clinical improvement were achieved in 13 of 25 patients (52%) by thrombolytic therapy and subsequent balloon angioplasty. The recanalization rate did not differ among the different thrombolytic drugs. However, rt-PA therapy resulted in reopening after 4 days of treatment; streptokinase, after 6 days; and urokinase, after 9 days (P < 0.005). No major complications or deaths occurred.
Thrombolytic treatment followed by balloon angioplasty may help avoid the need for aorto-bifemoral prosthetic bypass grafting in more than 50% of patients with chronic aortoiliac disease.
评估重新开通慢性闭塞性主动脉分叉的非手术替代方法。
非对照随机研究。
大学附属血管疾病转诊中心。
39例连续性慢性主髂动脉疾病患者中，25例包括完全闭塞的主动脉分叉被认为是主动脉双股人工血管移植的合适候选者。
患者被随机分配接受链激酶、尿激酶或重组组织型纤溶酶原激活剂（rt-PA）治疗。在溶栓成功且存在残余梗阻的情况下，尝试进行后续球囊血管成形术。如果溶栓治疗和球囊血管成形术失败，则进行人工血管旁路移植术。
25例患者中有5例（20%）实现了完全溶解。10例（40%）患者溶解后仍有残余梗阻，其中8例通过机械方法重新开通；2例患者进行了解剖外旁路移植术。10例（40%）未进行溶栓治疗的患者接受了手术主动脉双股旁路移植术。总体而言，通过溶栓治疗及后续球囊血管成形术，25例患者中有13例（52%）实现了再通和临床改善。不同溶栓药物的再通率无差异。然而，rt-PA治疗在治疗4天后实现再通；链激酶在6天后；尿激酶在9天后（P<0.005）。未发生重大并发症或死亡。
溶栓治疗后行球囊血管成形术可能有助于超过50%的慢性主髂动脉疾病患者避免进行主动脉双股人工血管旁路移植术。
