Angiojet血栓抽吸系统联合置管溶栓在急性肢体动脉栓塞疾病中的应用

目的观察并总结Angiojet血栓抽吸系统联合置管溶栓在急性肢体动脉栓塞疾病治疗中的临床疗效及经验。 方法回顾性分析安徽医科大学附属合肥医院介入血管疼痛科2015年3月至2016年5月应用Angiojet血栓抽吸系统联合置管溶栓治疗18例急性肢体动脉栓塞疾病患者的临床资料。描述其临床治疗效果及并发症发生情况。 结果所有18例患者均使用了Angiojet血栓抽吸系统来处理血管闭塞段,治疗后闭塞段均得到了有效开通,其开通率为100%,术中术后均未出现出血、穿孔等严重并发症。 结论Angiojet血栓抽吸系统联合置管溶栓在治疗急性肢体动脉栓塞疾病方面具有疗效显著、创伤小、安全性高等优点,可以作为急性肢体动脉栓塞患者的一种治疗选择。     

介入治疗急性下肢深静脉血栓的疗效观察

【目的】探讨介入治疗急性下肢深静脉血栓的临床疗效。【方法】选择急性下肢深静脉血栓患者168例,经股静脉或经右颈内静脉置入腔静脉滤器后,均行静脉置管溶栓治疗,溶栓治疗结束前复查肺动脉造影及下肢静脉造影,术后6个月复查血管超声。【结果】置入腔静脉滤器168枚均一次性释放成功,释放过程平均耗时1．9min。168例患者溶栓成功率100％,平均溶栓时间9．68d;98．8％（166／168）。患者肢体肿胀、疼痛症状消失或减轻;血栓直径消融75％～100％91例;血栓直径消融50％～75％47例;血栓直径消融小于50％30例,随访期间下肢静脉血栓直径与溶栓治疗结束时相比无增大。【结论】下腔静脉滤器置入术及下肢深静脉置管溶栓术治疗急性下肢深静脉血栓形成具有介入操作技术成功率较高、症状改善明显、血栓消融程度高、损伤小、安全性好的优点。     

Endovascular treatment of acute limb ischemia: review of current plasminogen activators and mechanical thrombectomy devices

Acute limb ischemia occurs in 15% to 20% of patients with chronic peripheral arterial disease. Off-label use of tissue plasminogen activators is the most common approach for patients with ischemic limbs that can wait 24 to 48 hours to restore flow. In the past decade, mechanical thrombectomy devices that use aspiration, maceration, or ultrasound waves have been developed to allow more rapid restoration of flow. Combination therapy with both mechanical and pharmacologic thrombolysis has become commonplace without randomized data to support its use. This article reviews acute limb ischemia and data regarding pharmacologic and mechanical thrombolysis.     

经导管溶栓治疗糖尿病下肢血管病变的同期护理

[目的]探讨挤压与按摩的护理方法对经导管溶栓治疗糖尿病下肢血管病变的疗效.[方法]32例病人共61枚肢体随机分威对照组与试验组.试验组在动脉留置导管溶栓的同时,应用挤压与按摩的护理.[结果]试验组病人血管的再通率明显高于对照组.[结论]经导管溶栓治疗糖尿病下肢血管病变期间,配合挤压与按摩的护理方式可以明显地提高疗效.     

Acute lower limb ischemia: a case study.

Acute ischemia of the lower extremity is a limb and life-threatening situation that demands prompt recognition and immediate treatment. The leading cause of acute limb ischemia is typically an arterial embolus of cardiac origin. Other significant causes are thrombosis of an atherosclerotic vessel and arterial injury/trauma. This case study examines complexities of diagnosis and treatment of acute ischemia while focusing on nursing care of a patient with an acute embolic occlusion.     

介入治疗下肢动脉缺血性疾病的中长期疗效分析

【目的】探讨介入治疗下肢动脉缺血性疾病的中长期疗效。【方法】选择下肢动脉缺血性疾病的患者106例,其中42例患者经数字减影血管造影（DSA）证实为髂动脉和／或股动脉闭塞,64例髂动脉和／或股动脉、胭动脉不同程度管腔狭窄,术中采用经导管动脉内溶栓治疗64例,机械开通31例,经皮血管腔内成形术（PTA）101例,支架置入69例（116枚支架）,术后随访12～60个月,分析介入治疗后的中长期疗效。【结果】术中未出现血管破裂、穿孔等严重并发症;术后所有患者下肢缺血症状明显减轻或消失。随访期间1例患者于术后15个月死于急性心肌梗死,21例患者再次出现下肢缺血症状,经DSA检查6例内膜增生引起支架阻塞,6例非治疗部位血管病变进展所致下肢缺血,9例溶栓及PTA治疗部位血管再狭窄,均经PTA或支架置入治疗后症状好转出院;其余84例症状无复发,血管超声复查提示管腔通畅、血流良好。【结论】介入治疗下肢动脉缺血性疾病操作创伤小、中长期疗效好,具有良好的临床应用价值。     

Acute and long-term results after intra-arterial thrombolysis of occluded lower extremity bypass grafts using recombinant tissue plasminogen activator for acute limb-threatening ischemia

Occlusion of lower extremity vascular bypass grafts results in acute limb-threatening ischemia. The underlying cause of graft failure generally is distal anastomosis stenosis, and relief of culprit stenosis is a required to maintain long-term patency. Of the three thrombolytic agents used for prolonged infusion to accomplish fibrinolysis, streptokinase was the first to be used and is limited owing to the antigenicity that precludes repeated use. Urokinase had been the mainstay of thrombolytic therapy until it was withdrawn by the U.S. Food and Drug Administration in 1999 because of the potential of transmission of infectious agents during its manufacturing process. Recombinant tissue plasminogen activator (rt-PA) has not been studied adequately to assess safety and efficacy, and there are no standardized dosing guidelines. We report our experience with six patients presenting with acute limb-threatening ischemia attributable to thrombosis of synthetic lower extremity bypass grafts. After thrombolysis using rt-PA (mean bolus dose, 12.2 +/- 3.6 mg; range, 6-15 mg administered over 5 minutes followed by infusion at 2 mg/h for 15.6 +/- 6.4 hours; total dose, 51 +/- 16 mg), successful thrombolysis was achieved in 84% of the patients. The primary patency rate was 75% and the secondary patency rate 100% at 16 weeks. One patient underwent amputation owing to unsuccessful thrombolysis. No major bleeding or vascular complications occurred. We conclude that intra-arterial thrombolysis using rt-PA is a safe and effective therapy for patients with thrombotic occlusion of synthetic lower extremity bypass grafts presenting with acute limb-threatening ischemia and allows a high rate of secondary patency, avoiding amputation.     

Medical management of peripheral arterial disease

Whether symptomatic or not, peripheral arterial disease (PAD), atherosclerosis in the arteries of the lower extremities, is a common disorder in the general population. The prevalence increases with age and under the influence of vascular risk factors. The most classic symptomatic expression of PAD is intermittent claudication. However, the majority of patients with PAD is asymptomatic or has leg symptoms other than classic intermittent claudication. Both symptomatic and asymptomatic subjects with PAD have increased mortality rates, mainly due to cardiovascular and cerebrovascular expressions of atherosclerotic disease. This review focuses on the current available medical therapies for PAD, including risk-factor modification and antiplatelet therapies, as well as strategies for symptomatic relief in both patients with intermittent claudication and patients with critical limb ischemia. In general, risk factor modification and antiplatelet therapy is essential in all patients with PAD to prevent systemic atherosclerotic complications. Furthermore, for symptomatic relief exercise therapy is the main intervention while pharmacological treatment should be only complementary. In patients with critical limb ischemia, when revascularization therapy is not possible, an attempt should be made to avoid amputation with conservative treatment using analgesics, vasodilators and/or anticoagulants. In case of an acute onset of critical limb ischemia, thrombolysis is indicated.     

经导管局部溶栓治疗肢体动脉闭塞疾病的疗效及影响因素

目的　探讨经导管局部溶栓治疗肢体动脉闭塞疾病的疗效及影响因素。方法　经导管小剂量持续步进输注尿激酶治疗 17例患者 ,2 1段肢体闭塞动脉。结果　急性动脉闭塞尿激酶平均用量 75万IU ,血管再通率 10 0 % ( 5 /5段 ) ;慢性动脉闭塞尿激酶平均剂量 2 2 5万IU ,溶栓成功率 81% ( 13 /16段 )。结论　经导管小剂量持续步进输注尿激酶为肢体动脉闭塞溶栓的有效治疗方法 ;溶栓治疗同时应使用抗凝剂 ;肢体动脉闭塞性疾病溶栓受诸多因素影响。     

通塞脉片对糖尿病下肢动脉闭塞患者介入术后的影响

目的探讨通塞脉片在糖尿病下肢动脉闭塞患者接受下肢动脉介入术后的治疗效果。方法收集78例糖尿病下肢动脉闭塞严重肢体缺血患者的临床资料,根据患者术后是否服用通塞脉片分为观察组和对照组,对照组介入术后接受抗血小板药物治疗,观察组在抗血小板药物基础上加用通塞脉片。比较2组临床治疗效果。结果总体手术成功率94%,观察组和对照组的手术成功率、补救性支架植入率、开通的膝下动脉支数比较差异均无统计学意义(P均> 0.05)。随访6个月时,观察组2例(5%)患者分别死于心肌梗死和脑梗死,对照组1例(3%)患者死于心肌梗死。观察组和对照组的总体保肢率分别为81%和67%,临床症状驱动的靶血管再血管化率分别为17%和14%。2组患者总体保肢率、再血管化率和全因死亡率比较差异均无统计学意义(P均> 0.05)。观察组患者小截肢率低于对照组(14%vs. 33%,P <0.05)。对术前患者肾功能进行分层分析,肾功能正常患者中观察组的小截肢发生率低于对照组(11%vs. 35%,P <0.05)。结论糖尿病下肢动脉闭塞患者接受下肢动脉介入手术效果确切,通塞脉片有助减少患者术后小截肢的风险...     

直流电刺激法制备动脉血栓模型的实验研究

目的 为研究物理性血栓溶解疗法而评价直流刺激制备动脉血栓模型方法的可行性。方法 新西兰大白兔60只均分为A、B、C3组,分别以直流电刺激法、注入凝血酶法和损伤血管内膜法制备动脉血栓模型,3h为实验终点。结果 直流电刺激法（A组）制备的动脉血栓模型成功率100％。其成功率,血栓质量及其对血管壁完整性的维护等均优于传统的注入凝血酶法（B组）或损伤血管内膜法（C组）。结论 推广使用直流电刺激制备血栓模型的方法。以增加进一步溶栓实验的科学性和可信性。     

Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in acute lower limb ischaemia

For various reasons some patients are unable to undergo intra-arterial thrombolysis for acute limb ischaemia. This interventional case series study prospectively evaluated the effect of thrombolytic treatment with 100 mg recombinant tissue plasminogen activator (rt-PA), administered intravenously, in patients with acute thrombosis of the lower limb arteries and onset of symptoms within 12 h prior to treatment. During a 3-year period (2007-2009), 18 of 86 patients satisfied the inclusion criteria and were included in the study (age range 65-80 years; 11 women). Complete and partial thrombolysis was observed in eight (44.4%) and six (33.3%) patients, respectively. All patients experienced clinical improvement. There were no amputations during the 36-month follow-up period and no haemorrhagic complications in the first 30 days post-treatment. Five patients died (27.8%) during follow-up from unrelated causes. This small study demonstrated that thrombolytic treatment with intravenous rt-PA in selected patients with acute limb ischaemia is feasible.     

Balloon-expandable stent placement in patients with immediate reocclusion after initial successful thrombolysis of acute middle cerebral arterial obstruction

We present the results of our approach for treating 12 consecutive cases of acute middle cerebral artery (MCA) stroke by performing balloon-expandable stent (BES) placement after immediate reocclusion due to the underlying stenosis after intra-arterial thrombolysis (IAT). We retrospectively reviewed the clinical outcomes of 12 patients with acute MCA stroke who underwent recanalization by BES placement in an underlying stenosis after IAT. The time to treatment, urokinase dose, duration of the procedure, recanalization rates and symptomatic hemorrhage were analyzed. Clinical outcome measures were assessed on admission and at discharge (the National Institutes of Health stroke scores [NIHSS]) as well as three months after treatment (modified Rankin scales [mRS]). The median NIHSS score on admission was 8.6. Four patients received IV rtPA. The median time from symptom onset to IAT was 236 minutes and the median duration of IAT was 62 minutes. The median dose of urokinase was 140,000 units. Initial recanalization after stent deployment (thrombolysis in cerebral ischemia attack grade of II or III) was achieved in all patients. Two patients died in the hospital due to aspiration pneumonia during medical management. In two patients, in-stent reocclusion occurred within 48 hours after stent deployment. At discharge, the median NIHSS score in ten patients (including the patients with reobstruction) was 2.4. The three-month outcome was excellent (mRS, 0-1) in eight patients. In this study, BES deployment was safe and effective in patients with an immediately reoccluded MCA after successful IAT.     

Recurrent thrombosis in the lower extremities after thrombectomy in a patient with polycythemia vera: A case report

BACKGROUNDAcute arterial embolism of the extremities is a surgical emergency. Atrial fibrillation is the major etiology of acute arterial embolism of the extremities. Emergency femoral artery thrombectomy can successfully treat this issue. However, polycythemia vera (PV) may sometimes explain this medical emergency. Recurrent thrombosis in the lower extremities after thrombectomy can be found in patients with PV, and reoperation is needed for this condition.CASE SUMMARYA 68-year-old man in China suffered from sudden pain in the left lower extremity for 14 h. The examination in the emergency department showed a diagnosis of acute arterial embolism of the extremities combined with PV. The patient’s complaint disappeared after repeat emergency thrombectomy.CONCLUSIONPatients with acute arterial embolism of the extremities should be treated carefully, especially those who have recurrent thrombosis after emergency thrombectomy. Clinicians should be aware of PV, a rare cause of acute arterial embolism of the extremities. The combination of thrombectomy, phlebotomy, and antiplatelet and anticoagulant drugs may be a suitable therapeutic regimen for these patients.     

Treatment of Limb Ischemia with Conducted Effects of Catheter-Based Endovascular Ultrasound

Ultrasound (US) is known to stimulate endogenous shear-dependent pathways, and can lower microvascular resistance through mediators that are conducted downstream from US exposure. We hypothesized that endovascular US, already in use for thrombolysis in humans, can improve tissue perfusion in the setting of acute limb ischemia through downstream-conducted effects. Models of severe peripheral arterial disease were developed in mice and in rhesus macaques. An endovascular US catheter (2.3 MHz, 0.5–1.1 MPa) was used to expose the limb adductor in mice for 10 min or the femoral artery distal to stenosis in macaques for 15 min. Quantitative contrast-enhanced ultrasound perfusion imaging was performed to assess flow augmentation in the adductor muscle of mice and the calf muscle of macaques. Microvascular blood flow in the ischemic limb relative to the contralateral control limb was reduced to 22 ± 8% in mice and 36 ± 20% in macaques. US produced immediate 2.3- and 3-fold increases (p < 0.05) in the murine and macaque ischemic limbs, respectively. In macaques, perfusion in the ischemic limb was increased to a normal level. We conclude that non-cavitating US produced by endovascular catheters that are used to enhance thrombolysis in humans can reduce vascular resistance and increase limb perfusion in the setting of acute ischemia.     

经导管溶栓及支架植入术治疗肠系膜上动脉闭塞性肠缺血

目的 评价经导管溶栓及支架植入术治疗肠系膜上动脉(SMA)闭塞性缺血的有效性.方法 14例SMA闭塞性缺血患者,男7例,女7例,年龄48～84岁(平均61.5岁),其中SMA粥样硬化性狭窄7例,SMA夹层性狭窄2例,SMA血栓性闭塞5例;表现为急性腹痛及慢性间歇性腹痛伴进食后加重各7例,其中2例伴有血便.8例SMA患者各植入1枚支架;另6例先行溶栓治疗,其中1例溶栓后植入支架.结果 经导管溶栓及支架植入术后,14例SMA均获得通畅.术后2～24 h患者腹痛均明显缓解或消失,均无并发症发生.随访2～19个月(平均12.8个月),1例于16个月死于心力衰竭,另13例未再发生肠缺血症状.结论 经导管溶栓及支架植入术是SMA闭塞性缺血安全、有效的治疗方法 .     

髂静脉受压综合征并下肢深静脉血栓形成的治疗探讨

目的 探讨手术取栓,经皮-大隐静脉置管溶栓联合支架置入治疗髂静脉受压综合征并急性左下肢深静脉血栓形成的临床效果。方法 对10例髂静脉受压综合征并急性左下肢深静脉血栓形成病人采用股静脉切开导管取栓,经皮、大隐静脉置管溶栓联合髂静脉支架置入治疗,静脉造影评价静脉通畅程度。10例均在术前行腹部和下肢增强CT检查明确诊断;7例增强CT见下腔静脉内血栓者行临时性下腔静脉滤器置入术后股静脉切开导管取栓,取栓术后经皮、大隐静脉置5 F导管鞘溶栓;3例直接行取栓溶栓治疗。10例均行球囊扩张及髂静脉支架置入术。结果 静脉造影示髂静脉再通率100%;术后患肢肿胀症状明显减轻或消失。结论 手术取栓、经皮经大隐静脉置管溶栓联合髂静脉支架置入是治疗髂静脉受压综合征并急性左下肢深静脉血栓形成的有效方法 之一;术前腹部和下肢增强CT检查可明确下腔静脉有无血栓形成从而为置入滤器提供证据。     

急性肺血栓栓塞症溶栓疗效评价

目的应用多层螺旋CT肺动脉造影评价急性肺血栓栓塞症(PTE)尿激酶溶栓治疗前后血栓的变化。方法总结分析18例急性PTE患者临床表现,溶栓前后实验室检查及心脏超声的变化,应用多层螺旋CT计数溶栓前后血栓累及肺段数量。结果本组患者以胸闷、气短为主诉就诊,院前误诊率(88.9%,16/18),3例(16.7%)曾出现晕厥,经溶栓治疗后临床症状明显缓解;心脏超声显示溶栓后右房、右室直径明显缩小(P<0.05);多层螺旋CT肺动脉造影显示血栓累及肺段数量溶栓后明显减少(P<0.001);其中6例患者血栓完全消失,溶栓治疗前与治疗后的血栓累及肺段数量有相关性(r=0.742,P<0.001)。结论尿激酶溶栓方案对于PTE安全有效,多层螺旋CT肺动脉造影能够明确显示溶栓治疗前后血栓的变化,可作为评价治疗效果的重要客观检查。     

手术结合置管溶栓治疗急性下肢深静脉血栓形成

目的 总结急性下肢深静脉血栓形成手术取栓后留置导管溶栓的经验。方法 手术取栓后留置导管溶栓者31例，均为混合性。股青肿7例，股白肿2例。术前全部放置下腔静脉滤器。结果 术后7d经留置导管静脉造影示28例患肢深静脉全程通畅。静脉壁光滑无返流；1例胭静脉狭窄50％，2例胫前静脉部分再通。随访：29例症状全部消失，2例穿弹力袜后能正常工作。结论 手术取栓结合留置导管溶栓治疗急性下肢深静脉血栓形成疗效肯定。可以减少下肢深静脉血栓形成后遗症。     

A case of phlegmesia cerulea dolens after dialysis catheter insertion

Phlegmesia cerulea dolens (PCD) is a rare complication of deep vein thrombosis characterized by massive venous thrombosis leading to arterial compromise and tissue ischaemia. PCD carries high morbidity and mortality and is an often times overlooked cause of acute limb ischaemia that must be recognized and treated promptly. Early referral for percutaneous catheter directed thrombectomy offers an alternative to thrombolysis in patients who present with venous gangrene or fail anticoagulation therapy. A case of PCD is presented in a 71‐year‐old woman with end‐stage renal disease 3 days after right femoral dialysis catheter placement.