Diffin D C, Kandarpa K
Brigham and Women's Hospital, Boston, Mass., USA.
J Vasc Interv Radiol. 1996 Jan-Feb;7(1):57-63. doi: 10.1016/s1051-0443(96)70734-0.
To review the risks and benefits of using peripheral intraarterial thrombolysis (PIAT) versus surgical revascularization (SR) as the initial treatment of acute lower-limb ischemia (ALLI).
Two prospective, randomized trials that compared PIAT with SR in the treatment of ALLI were analyzed along with recent large, retrospective studies. Overall, 1,051 SR cases and 895 PIAT cases were included; when possible, the ischemic events were further categorized as acute, chronic, embolic, or thrombotic. Limb salvage and mortality at 30-day and 6-12-month follow-up were assessed. Combined percentages were derived by proportionally weighing each study.
When all studies were combined, limb salvage rates were 93% for PIAT and 85.5% for SR at 30 days and 89% versus 73%, respectively, at 6-12-month follow-up. Mortalities were 4% versus 15%, respectively, at 30 days and 8% versus 29%, respectively, at 6-12-month follow-up.
PIAT is associated with a substantially better limb-salvage rate and mortality than SR in the treatment of ALLI.
回顾将外周动脉内溶栓术（PIAT）与外科血管重建术（SR）作为急性下肢缺血（ALLI）初始治疗方法的风险和益处。
分析了两项比较PIAT与SR治疗ALLI的前瞻性随机试验以及近期大型回顾性研究。总体纳入了1051例SR病例和895例PIAT病例；在可能的情况下，将缺血事件进一步分类为急性、慢性、栓塞性或血栓性。评估了30天及6至12个月随访时的肢体挽救情况和死亡率。通过按比例权衡每项研究得出合并百分比。
当所有研究合并时，PIAT在30天时的肢体挽救率为93%，SR为85.5%；在6至12个月随访时，分别为89%和73%。30天死亡率分别为4%和15%，6至12个月随访时分别为8%和29%。
在治疗ALLI方面，PIAT与SR相比，肢体挽救率和死亡率显著更好。
