69例急性下肢缺血的诊治分析

目的探讨急性下肢缺血的治疗方法及预后。方法回顾性分析我科2007年1月～2012年1月治疗69例急性下肢缺血患者的临床资料,其中急性动脉栓塞14例,动脉硬化闭塞基础上继发急性血栓形成50例,血栓闭塞性脉管炎3例,不明原因2例。根据病情采用:动脉切开Fogarty导管取栓8例,人工血管旁路17例;球囊扩张成形/支架置入15例;置管溶栓后进一步行腔内治疗12例;低位静脉动脉化2例;单纯药物治疗9例;I期截肢6例。结果 12例(17.4%)治疗成功,50例(72.5%)治疗好转,1例(1.4%)治疗无效。57例(82.6%)患者获得随访,随访时间3～62(平均26.4)个月,42例症状不同程度改善,7例Ⅱ期截肢,5例死于心、肺疾病。结论急性下肢缺血早期诊断与及时采用合适的治疗方法是治疗成功的关键。

Diagnosis and treatment of 69 cases with acute lower limb ischemia

Objective To explore the treatment and prognosis of acute lower limb ischemia. Methods From January 2007 to January 2012, the clinical data of 69 patients with acute lower limb ischemia were analyzed retrospectively. Among them, 14 cases were acute arterial embolism, 50 cases were secondary acute thrombosis on the basis of arteriosclerosis obliterans, 3 cases were thromboangiitis obliterans and 2 cases were unknown causes. Different treatments were carried out according to their conditions. Eight patients underwent Fogarty catheter embolectomy,17 patients had artificial vascular bypass and 15 patients received balloon dilatation or stenting. 12 cases underwent further endovascular treatment after catheter-directed thromboysis,2 cases underwent venous arterialization,9 cases received medication treatment and 6 cases were performed amputation. Results 12 cases (17.4%) were treated successfully, 50 cases (72.5%) improved, while 1 case (1.4%) ineffective. 57 patients were followed up for 3 to 62 months. The conditions in 42 patients improved, 7 patients underwent amputation in the second phase, and 5 patients died of cardiopulmonary failure. Conclusion The early diagnosis of acute lower limb ischemia and adoption of appropriate treatment in time are the keys to successful treatment.