Parsons R E, Marin M L, Veith F J, Sanchez L A, Lyòn R T, Suggs W D, Faries P L, Schwartz M L
Department of Surgery, Montefiore Medical Center, University Hospital, Albert Einstein College of Medicine, New York, NY, USA.
Ann Vasc Surg. 1996 May;10(3):201-10. doi: 10.1007/BF02001883.
We performed bilateral femoral artery dissections in a single 50 kg mongrel dog. Digital fluoroscopic arteriograms documented the luminal diameter of the left iliac and right superficial femoral arteries. Balloon thrombectomy catheter passage was performed through hemostatic sheaths by 12 surgeons. Embolectomy balloons were filled with radiographic contrast material and the balloon catheter diameter was compared with the underlying vessel diameter. The percentage of overdistention of the embolectomy balloon relative to the arterial wall was 23% +/- 5% in the iliac artery and 40% +/- 13% in the femoral artery. Over a 25-month period, we used fluoroscopically assisted thromboembolectomy to treat 21 patients with acute arterial or graft occlusions. As the balloon was gently withdrawn to extract intravascular thrombus, deformities of the compliant balloon profile caused by underlying arterial lesions were identified fluoroscopically and their locations recorded to facilitate further treatment. After initial clot removal in these 21 patients, 15 residual lesions were documented. Repeat thrombectomy (n = 8), balloon angioplasty (n = 3), and placement of intravascular stents (n = 4) eliminated all 15 lesions. Luminal continuity was successfully restored in all 21 of these patients, 10 of whom required distal open vascular reconstruction to correct existing outflow artery disease. Fluoroscopically assisted thromboembolectomy is a simple and safe method for treating acute arterial or graft occlusions in patients with diffuse arteriosclerosis. It minimizes arterial damage and blood loss during balloon thrombectomy and reduces the need for intravascular contrast agents. It also has the potential to facilitate accurate identification, localization, and treatment of significant underlying arterial lesions.
我们在一只50千克的杂种犬身上进行了双侧股动脉夹层分离术。数字荧光血管造影记录了左髂动脉和右股浅动脉的管腔直径。12名外科医生通过止血鞘进行球囊取栓导管置入。将取栓球囊充满造影剂，并将球囊导管直径与下方血管直径进行比较。取栓球囊相对于动脉壁的过度扩张百分比在髂动脉中为23%±5%，在股动脉中为40%±13%。在25个月的时间里，我们使用荧光透视辅助血栓切除术治疗了21例急性动脉或移植物闭塞患者。当球囊被轻轻抽出以取出血管内血栓时，通过荧光透视识别由潜在动脉病变引起的顺应性球囊外形变形，并记录其位置以利于进一步治疗。在这21例患者最初清除血栓后，记录到15处残留病变。重复取栓术（n = 8）、球囊血管成形术（n = 3）和血管内支架置入术（n = 4）消除了所有15处病变。这21例患者均成功恢复了管腔连续性，其中10例需要进行远端开放血管重建以纠正现有的流出道动脉疾病。荧光透视辅助血栓切除术是治疗弥漫性动脉硬化患者急性动脉或移植物闭塞的一种简单、安全的方法。它能在球囊取栓过程中使动脉损伤和失血降至最低，并减少血管内造影剂的使用需求。它还有助于准确识别、定位和治疗重要的潜在动脉病变。
