Changing Patterns of Atheroembolism
Changing Patterns of Atheroembolism
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动脉粥样硬化栓塞模式的变化
DOI：
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发表时间：
1996
期刊：
影响因子：
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通讯作者：
Nassoura
中科院分区：
文献类型：
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作者：
Pathanjali Sharma;C. S.;Babu;M. Shah;Z.;E.;Nassoura
在90个月期间（1986-1993）接受肾下主动脉和腹股沟下血管手术的1011例患者中，确定了29例（2.9%）具有动脉粥样硬化栓塞的临床、血管造影和病理证据。超过三分之一（44.8%）的动脉粥样硬化栓塞是医源性的，其余是自发性的。所有医源性动脉粥样硬化栓塞均由血管造影（n = 11; 84.6%）或手术操作（n = 2; 15.4%）引起。栓子来源于腹动脉（16）、髂动脉（7）和股腘动脉（6）。19例患者（7例双侧）发生了“垃圾脚”，7例患者出现胫腓动脉/指动脉闭塞，2例患者出现肾和皮肤微循环，1例患者出现小腿肌肉闭塞。在三种情况下（股总静脉、腘静脉和原位隐静脉移植物），较大的管道受到影响。治疗包括54例（43例外科手术和11例血管内）手术，同时进行溶栓、抗凝和抗血小板治疗。17例患者发生3例早期（10.3%）和2例晚期（6.9%）死亡（总死亡率17.2%）、8例大截肢（27.6%）和5例小截肢（17.2%）以及4例（13.8%）肾衰竭，导致58.6%的并发症发生率。除了最初的血管造影，25例患者需要53次侵入性手术。在这些患者中，12例患者可以通过一次明确的手术进行管理，而一组13例患者需要41次（平均每例患者3.2次）手术。自发性组的足部缺血、再次手术和截肢的发生率较高，而医源性组的血管内介入发生率较高，死亡率较高，新发肾衰竭。动脉粥样硬化栓塞的高发病率和死亡率要求及时识别和治疗，以及尝试预防以获得良好的结果。
Among 1011 patients undergoing infrarenal aortic and infrainguinal vascular surgery in a 90-month period (1986–1993), 29 patients (2.9%) with clinical, angiographic and pathologic evidence of atheroembolism were identified. Over one-third (44.8%) of atheroemboli were iatrogenic and the rest spontaneous. All iatrogenic atheroemboli were precipitated by angiographic (n = 11; 84.6%) or operative manipulation (n = 2; 15.4%). The sources of emboli were in the abdominal arota (16), iliac (seven) and femoropopliteal (six) arteries. ‘Trash foot’ occurred in 19 patients (seven bilateral) and occlusions of tibioperoneal/digital arteries were seen in seven, renal and dermal microcirculation in two each, and calf muscles in one. Larger conduits were affected in three instances (common femoral, popliteal and in situ saphenous vein graft). The management consisted of 54 (43 surgical and 11 endovascular) procedures concurrently with thrombolytic, anticoagulant and antiplatelet therapy. Three early (10.3%) and two late (6.9%) deaths (overall mortality rate 17.2%), eight major (27.6%) and five minor (17.2%) amputations, and four (13.8%) instances of renal failure occurred in 17 patients resulting in a 58.6% complication rate. Besides initial angiography, 53 invasive procedures were required in 25 patients. Among these, 12 patients could be managed with a single definitive procedure in contrast to a group of 13 patients that required 41 (average 3.2 per patient) procedures. The incidence of foot ischemia, reoperation and amputation was higher in the spontaneous group, whereas, the iatrogenic group incurred a higher incidence of endovascular interventions, greater mortality and new onset renal failure. The high morbidity and mortality of atheroemboli demand prompt recognition and treatment, as well as attempts at prevention to achieve good results.