Bhatnagar P K, Ierardi R P, Ikeda Y, Wada H, Wilson A, Khoury P, Karamonte C, Kerstein M, Matsumoto T
Department of Surgery, Hahnemann University School of Medicine, Phildelphia, PA, USA.
J Cardiovasc Surg (Torino). 1996 Apr;37(2):105-12.
The indications for intraarterial thrombolytic therapy of lower extremity native arterial and synthetic graft occlusions prior to vascular reconstructions requires further refinement before firm conclusions can be made.
A retrospective review of 55 patients undergoing 81 lytic treatments with high dose urokinase from February 1989 to February 1993 was performed. The cases were divided into three groups: Group I: successful thrombolysis with residual defects followed by surgical reconstruction or percutaneous transluminal angioplasty (PTA); Group II: successful thrombolysis alone; and Group III: failure of thrombolysis requiring reconstruction or leading to amputation. No effort was made to analyze the particular type of reconstruction. Follow-up ranged from 1 to 1627 days (4 years and 5 1/2 months).
One, two, and three year patency rates were 47%, 24%, and 8% for Group I; 57%, 46%, and 46% for Group II; and 24%, 10%, and 10% for Group III respectively. The one, two and three year limb salvage rates were 92%, 76%, and 76% for Group I; 82%, 82%, and 82% for Group II; and 48%, 37%, and 37% for Group III respectively. Forty-one complications occurred in 35 of the 81 (43%) lytic treatments.
Intraarterial thrombolytic therapy can be regarded as a possible consideration in the initial management of acute lower extremity arterial and synthetic graft occlusions especially in patients with multiple prior vascular reconstructions. Unsuccessful thrombolysis results in a poor outcome despite surgical reconstruction in the majority of cases.
在进行血管重建之前，下肢天然动脉和人工血管闭塞的动脉内溶栓治疗的适应症需要进一步完善，才能得出确切结论。
对1989年2月至1993年2月期间接受81次大剂量尿激酶溶栓治疗的55例患者进行回顾性研究。病例分为三组：第一组：溶栓成功但有残余病变，随后进行手术重建或经皮腔内血管成形术（PTA）；第二组：单纯溶栓成功；第三组：溶栓失败，需要进行重建或导致截肢。未对重建的具体类型进行分析。随访时间为1至1627天（4年零5个半月）。
第一组的1年、2年和3年通畅率分别为47%、24%和8%；第二组分别为57%、46%和46%；第三组分别为24%、10%和10%。第一组的1年、2年和3年肢体挽救率分别为92%、76%和76%；第二组分别为82%、82%和82%；第三组分别为48%、37%和37%。81次（43%）溶栓治疗中有35次发生了41例并发症。
动脉内溶栓治疗可被视为急性下肢动脉和人工血管闭塞初始治疗的一种可能选择，特别是对于有多次既往血管重建的患者。尽管大多数病例进行了手术重建，但溶栓失败会导致不良后果。
