Rørdam P, Enevoldsen M T, Grønvall Rasmussen J B, Laursen N O, Hensler M K, Madsen P V, Schroeder T V
Karkirurgisk afdeling RK, Rigshospitalet, København.
Ugeskr Laeger. 1996 Sep 2;158(36):5018-21.
During a period of four and a half years 37 lower extremities with acute ischaemia were treated with thrombolysis. Angiographically, 35 cases demonstrated no suitable arteries for distal reconstruction. In two cases vascular surgery was not performed because of cardiac incompensation. Two patients died within one month and limb salvage was 69%. During 22 months (3-48) of follow-up another six patients were amputated two to nine months later. The 18 salvaged lower extremities (49%) had an ankle-brachial pressure index of 0.63 (0.30-1.-09). Review of all angiograms revealed a demonstrable effect of thrombolytic therapy only in 13 (35%) cases. In conclusion, thrombolytic therapy should be considered in the case of acute lower extremity ischaemia unsuitable for reconstructive procedures. Even though the effect of thrombolytic therapy cannot be demonstrated on the angiogram, that should not necessarily deem the treatment to be a failure.
在四年半的时间里，对37例急性下肢缺血患者进行了溶栓治疗。血管造影显示，35例患者没有适合进行远端重建的动脉。有2例患者因心脏失代偿未进行血管手术。2例患者在1个月内死亡，肢体挽救率为69%。在22个月（3 - 48个月）的随访中，另外6例患者在2至9个月后接受了截肢手术。18条得以挽救的下肢（49%）的踝肱压力指数为0.63（0.30 - 1.09）。回顾所有血管造影显示，仅13例（35%）患者的溶栓治疗有明显效果。总之，对于不适合进行重建手术的急性下肢缺血病例，应考虑溶栓治疗。即使血管造影无法显示溶栓治疗的效果，也不一定意味着治疗失败。
