Van Damme H, Trotteur G, Dongelinger R F, Limet R
Department of Cardiovascular Surgery, University Hospital of Liège, CHU du Sart-Tilman, Belgium.
Acta Chir Belg. 1997 Aug;97(4):177-83.
From January 1993 to December 1995, intraarterial catheter guided urokinase infusion was used as an initial approach in the management of 29 episodes of infrainguinal graft thrombosis (12 venous and 17 prosthetic grafts) in 27 patients. The infusion catheter was embedded inside the occluding clot which was infiltrated by 225.000 U urokinase from distal to proximal. Local low-dose urokinase (1.000 U/kg/hr) was continued for a mean of 39 hours. By this regimen, prompt relief of ischaemia was achieved in 69% (20/29) of cases. Complete recanalization was obtained in 79% of cases. In six cases, the graft remained totally (n = 3) or partially (n = 3) occluded. Two of these patients benefited from secondary surgery, two improved clinically by conservative treatment, and two required amputation. In the 23 successful cases, thrombolysis unmasked an underlying flow-limiting stenosis in 83% (19/23), that was subsequently corrected by percutaneous balloon angioplasty (n = 15), by surgery (n = 3), or by a combination of both (n = 4). One early rethrombosis resulted in an amputation. The immediate limb-salvage rate was 89% (26/29). Surgical intervention was avoided in 17 cases (58%). The main hospital stay was 13 days. The short-term follow-up (mean of 17 months) reveals a high early rethrombosis rate (8/23 or 35%) within one year. Four of these repeated graft failures evolved to amputation. At one year, the overall limb salvage rate dropped to 79%. Thrombolytic management of infrainguinal occluded bypass grafts gives excellent initial technical results (79%), minimizing the need for major surgical revision. It is however characterized by a high procedure-related morbidity (21%). These immediate favourable results are not longstanding. Diffuse graft disease, limited outflow and high recurrence rate of anastomotic stenoses after balloon angioplasty explain poor long-term results after thrombolysis of failed grafts.
1993年1月至1995年12月，27例患者发生29次股下移植血管血栓形成（12例静脉移植血管和17例人工血管），初始治疗采用动脉内导管引导尿激酶灌注。将灌注导管置于闭塞性血栓内，从远端至近端注入225000 U尿激酶使血栓浸润。局部低剂量尿激酶（1000 U/kg/小时）持续平均39小时。通过该治疗方案，69%（20/29）的病例缺血症状迅速缓解。79%的病例实现完全再通。6例患者移植血管仍完全（n = 3）或部分（n = 3）闭塞。其中2例患者接受二次手术获益，2例经保守治疗临床症状改善，2例需要截肢。在23例成功病例中，83%（19/23）的患者溶栓后发现存在潜在的血流限制性狭窄，随后分别通过经皮球囊血管成形术（n = 15）、手术（n = 3）或两者联合（n = 4）进行纠正。1例早期再血栓形成导致截肢。肢体即刻挽救率为89%（26/29）。17例（58%）患者避免了手术干预。主要住院时间为13天。短期随访（平均17个月）显示，1年内早期再血栓形成率较高（8/23或35%）。其中4例移植血管反复闭塞最终导致截肢。1年时，总体肢体挽救率降至79%。股下闭塞性旁路移植血管的溶栓治疗在初始技术方面效果极佳（79%），最大限度减少了大手术翻修的需求。然而，其特点是与操作相关的发病率较高（21%）。这些即刻的良好效果并不持久。弥漫性移植血管病变、流出道受限以及球囊血管成形术后吻合口狭窄的高复发率导致溶栓失败的移植血管长期效果不佳。
