Brossmann J, Müller-Hülsbeck S, Heller M
Klinik für Radiologische Diagnostik, Christian Albrechts Universität Kiel.
Rofo. 1998 Oct;169(4):344-54. doi: 10.1055/s-2007-1015298.
Treatment of acute embolic and thrombotic occlusions of arteries has to be initiated immediately to save the limb at risk. Surgery has been the treatment of choice for the last decades. Percutaneous mechanical methods for thrombectomy and thrombolysis have evolved and offer alternative treatment options, reducing the peri-operative risk. Percutaneous aspiration thrombembolectomy (PAT), recirculation thrombectomy with the Amplatz device, and different systems for hydrodynamic thrombectomy and thrombolysis (Angiojet, Hydrolyer, S.E.T. catheter) are routinely used for percutaneous thrombectomy and mechanical thrombolysis. These 3.5-10 F systems allow for the rapid removal of a fresh clot from different vascular regions. Complete removal of the clot can be achieved in 19-49%; adjunctive use of other percutaneous methods (thrombolysis and thrombectomy: 60-80%; PTA and atherectomy: 81-100%) results in primary success rates of 67-100% for recanalization of acutely occluded vessels. Primary indications for percutaneous thrombectomy and mechanical thrombolysis are acute occlusions of peripheral arteries and dialysis fistulas; limited experience exists for the treatment of occlusions of the visceral and pelvic vessels. Percutaneous methods seem promising for treatment of acute pulmonary embolism.
必须立即开始对急性动脉栓塞和血栓形成性闭塞进行治疗，以挽救处于危险中的肢体。在过去几十年中，手术一直是首选的治疗方法。经皮血栓切除术和溶栓的机械方法不断发展，并提供了替代治疗选择，降低了围手术期风险。经皮抽吸血栓切除术（PAT）、使用Amplatz装置的再循环血栓切除术以及用于水力血栓切除术和溶栓的不同系统（Angiojet、Hydrolyer、S.E.T.导管）通常用于经皮血栓切除术和机械溶栓。这些3.5 - 10F的系统能够快速从不同血管区域清除新鲜血栓。19% - 49%的病例可实现血栓的完全清除；辅助使用其他经皮方法（溶栓和血栓切除术：60% - 80%；经皮腔内血管成形术和斑块旋切术：81% - 100%）可使急性闭塞血管再通的初次成功率达到67% - 100%。经皮血栓切除术和机械溶栓的主要适应证是外周动脉和透析瘘的急性闭塞；对于内脏和盆腔血管闭塞的治疗经验有限。经皮方法在治疗急性肺栓塞方面似乎很有前景。
