Lang E V, Stevick C A
Department of Radiology, Veterans Administration Medical Center, Palo Alto, CA.
J Vasc Interv Radiol. 1993 Jul-Aug;4(4):481-8. doi: 10.1016/s1051-0443(93)71901-6.
Transcatheter methods of revascularization were performed in 11 patients with severe acute lower extremity ischemia and extensive vascular occlusions in whom surgical revascularization was not possible (10 patients) or was not preferred (one patient).
The acute ischemia was considered category 2 in nine patients and category 3 in two. Vascular occlusions were located in the superficial femoral artery in four patients, popliteal artery in 10, all three crural arteries in 10, and two crural arteries in one. Transcatheter methods included accelerated thrombolysis with 325,000 to 1.75 million U of urokinase, adjunct angioplasty, use of intraarterial vasodilators, and creation of pedal arterial flow loops.
Initial success was 100% in the nine patients with category 2 ischemia. Eight limbs were saved; one occlusion at 10 days necessitated below-knee amputation. For the two patients with category 3 ischemia, one procedure failed and the other reduced the level of amputation.
In patients with severe acute ischemia, transcatheter revascularization is a viable treatment option when strategies for reperfusion establish both inflow and microcirculatory outflow.
对11例严重急性下肢缺血且存在广泛血管闭塞、无法进行外科血管重建术（10例）或患者不希望进行外科血管重建术（1例）的患者实施经导管血管重建术。
9例患者的急性缺血被归为2类，2例归为3类。血管闭塞位于股浅动脉的有4例，腘动脉的有10例，所有三条小腿动脉的有10例，两条小腿动脉的有1例。经导管方法包括使用32.5万至175万单位尿激酶进行加速溶栓、辅助血管成形术、使用动脉内血管扩张剂以及建立足部动脉血流环。
9例2类缺血患者的初始成功率为100%。保住了8条肢体；1例在10天时出现血管闭塞，需要进行膝下截肢。对于2例3类缺血患者，1例手术失败，另1例降低了截肢平面。
对于严重急性缺血患者，当再灌注策略建立了流入和微循环流出时，经导管血管重建术是一种可行的治疗选择。
