#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Intraarterial Peroperative Thrombolysis in Therapy of the Acute Limb Ischemia


Authors: P. Baláž;  S. Rokošný;  J. Chlupáč;  L. Janoušek;  M. Adamec
Authors place of work: Cévní oddělení, Klinika transplantační chirurgie, IKEM Praha, přednosta: prof. MUDr. M. Adamec, CSc.
Published in the journal: Rozhl. Chir., 2011, roč. 90, č. 1, s. 55-58.
Category: Monothematic special - Original

Summary

Acute limb ischemia is serious situation, jeopardizing limb salvage, causing embolization or trombosis of the native arteries or vascular graft. Immediate surgical revascularization with baloon tromboembolectomy is indicated in patient with acute ischemia stage IIB of the Rutherford clasification. Unfortunately, operative thromboembolectomy is frequently incomplete, with persistent thrombus remaining in the majority of patients. Residual thrombus compromises the clinical outcome, leading to poor revascularization and an increased risk of tissue loss. On depending of amount of the residual trombus after surgical tromboembolectomy, we can choose one of the three options of intraoperative thrombolysis. This article summarized indication and technical realisation of intraoperative thrombolysis and describe cause report of the first patient treated with this method in our country. The combined use of intraoperative thrombolytics following mechanical thromboembolectomy is safe and efficacious method in patients with acute vascular occlusion.

Key words:
acute ischemia – tromb/embolectomy - thrombolysis


Zdroje

1. Rutherford, R. Acute limb ischemia: Clinical assessment and standards for reporting. Semin. Vasc. Surg., 1992; 5: 4–10.

2. Rutherford, R., Baker, J., Ernst, C., et al. Recommended standards for reports dealing with lower extremity ischemia: Revised version. J. Vasc. Surg., 1997; 26: 517–538.

3. Norgren, L., Hiatt, W., Dormandy, J., et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J. Vasc. Surg., 2007; 45 (Suppl. S): S5–S67.

4. Plecha, F., Pories, W. Intraoperative angiography in the immediate assessment of arterial reconstruction. Arch. Surg., 1972; 105: 902–907.

5. White, G., White, R., Kopchok, G., et al. Angioscopic thromboembolectomy: Preliminary observations with a recent technique. J. Vasc. Surg., 1988; 7: 318–325.

6. Comerota, A., Sidhu, R. Can Intraoperative Thrombolytic Therapy Assist with the Management of Acute Limb Ischemia? Semin. Vasc. Surg., 2009; 22: 47–51.

7. Greep, J., Aleman, P., Jarrett, F., et al. A combined technique for peripheral arterial embolectomy. Arch. Surg., 1972; 105: 869–874.

8. Parent, F., Bernhard, V., Pabst, T., et al. Fibrinolytic treatment of residual thrombus after catheter embolectomy for severe lower limb ischemia. J. Vasc. Surg., 1989; 9: 153–160.

9. Norem, R., Short, D., Kerstein, M. Role of intraoperative fibrinolytic therapy in acute arterial occlusion. Surg Gynecol Obster., 1988; 167: 87–91.

10. Cohen, L., Kaplan, M., Bernhard, V. Intraoperative streptokinase. An adjunct to mechanical thrombectomy in the management of acute ischemia. Arch. Surg., 1986; 121: 708–715.

11. Comerota, A., Rao, A., Throm, R., et al. A prospective, randomized, blinded, and placebo-controlled trial of intraoperative intra-arterial urokinase infusion during lower extremity revascularization. Regional and systemic effects. Ann. Surg., 1993; 218: 534–541.

12. Bradbury, A., BASIL trial Investigators and Participants Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial in perspective. J. Vasc. Surg., 2010; 51 (Suppl. 5): 1S–4S.

13. Rutherford, R. Clinical Staging of Acute Limb Ischemia as the Basis for Choice of Revascularization Method: When and How to Intervene. Semin. Vasc. Surg., 2009; 22: 5–9.

Štítky
Surgery Orthopaedics Trauma surgery

Článok vyšiel v časopise

Perspectives in Surgery

Číslo 1

2011 Číslo 1
Najčítanejšie tento týždeň
Najčítanejšie v tomto čísle
Prihlásenie
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa

#ADS_BOTTOM_SCRIPTS#