Endovascular Treatment Strategy Using Catheter-Directed Thrombolysis, Percutaneous Aspiration Thromboembolectomy, and Angioplasty for Acute Upper Limb Ischemia
Endovascular Treatment Strategy Using Catheter-Directed Thrombolysis, Percutaneous Aspiration Thromboembolectomy, and Angioplasty for Acute Upper Limb Ischemia
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DOI：
10.1007/s00270-017-1599-z
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发表时间：
2017-07-01
影响因子：
2.9
通讯作者：
Kumita, Shin-Ichiro
中科院分区：
文献类型：
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作者：
Ueda, Tatsuo;Murata, Satoru;Kumita, Shin-Ichiro
目的评价多种血管内治疗方法治疗急性上肢缺血（奥利）的有效性和安全性，并比较导管溶栓（CDT）和经皮穿刺血栓抽吸术（PAT）作为初始治疗方法的疗效。（4名男性和14名女性）患有奥利，在2005年1月至2016年4月期间使用各种血管内技术共接受了20次血管内治疗。患者最初接受CDT [n = 9，基于CDT的组（C-G）]、PAT [n = 6，基于PAT的组（P-G）]或血管成形术（n = 3）治疗。在残留栓子的情况下，我们进行了额外的血管内技术。我们评估了技术成功、临床成功和并发症。此外，我们还比较了两组患者的尿激酶用量。结果患者平均年龄为74.4岁。所有患者均获得了技术和临床成功。18例患者中，1例仅接受CDT，2例仅接受PAT，1例仅接受血管成形术，14例接受多种技术。来自C-G的2例患者发生严重并发症（小脑出血1例;尺动脉分支假性动脉瘤1例）。P-G组尿激酶平均用量低于C-G组（40，000 vs.246，667 IU; Mann-Whitney U检验，P = 0.004）。多种血管内技术的组合对于成功治疗很重要。在血管内技术中，建议将PAT作为初始手术，因为尿激酶剂量较低，并发症发生率较低。
Purpose To evaluate the usefulness and safety of endovascular treatments for acute upper limb ischemia (AULI) by using multiple techniques, and to compare catheter-directed thrombolysis (CDT) and percutaneous aspiration thromboembolectomy (PAT) as initial procedures.Materials and Methods The study included 18 patients (4 men and 14 women) with AULI, who underwent a total of 20 sessions of endovascular treatment using various endovascular techniques between January 2005 and April 2016. The patients were initially treated with CDT [n = 9, CDT-based group (C-G)], PAT [n = 6, PAT-based group (P-G)], or angioplasty (n = 3). In case of residual emboli, we performed additional endovascular techniques. We assessed technical success, clinical success, and complications. Additionally, we compared the urokinase dosage between the groups.Results The mean patient age was 74.4 years. Technical and clinical success was obtained in all patients. Among the 18 patients, 1 underwent CDT only, 2 underwent PAT only, 1 underwent angioplasty only, and 14 underwent multiple techniques. Two patients from the C-G experienced major complications (cerebellar hemorrhage 1; pseudo-aneurysm in a branch of the ulnar artery 1). The mean urokinase dosage was lower in the P-G than in the C-G (40,000 vs. 246,667 IU; Mann-Whitney U test, P = 0.004).Conclusion Endovascular treatment is effective and safe for AULI. A combination of multiple endovascular techniques is important for successful treatment. PAT is suggested as an initial procedure among endovascular techniques, in terms of a lower dosage of urokinase and a lower complication rate.