动脉溶栓的时限.pptVIP

L/O/G/O 2016-5-7 Acute lower limb ischemia Aetiology: Thromboembolic disease Aortic dissection Arterial trauma Over the past two decades thrombosis has replaced embolism as the principal cause of acute ischemia and now account for approximately 59% of cases(UK) (Jonathan, Lower limb intra-arterial thrombolysis. Postgrad Med J 1995;71:146-150) Differential diagnosis Comparison of thrombosis and embolism Thrombosis Embolism Incidence 60% 40% Presentation Acute on chronic ischemia Acute white limb Past history Intermittent claudication Arterial fibrillation, recent myocardial infarction Examination Chronic ischemia may be present in other limb Pulse maybe present in other limb Treatment Thrombolysis Embolectomy (Jonathan, Lower limb intra-arterial thrombolysis. Postgrad Med J 1995;71:146-150) Indication for thrombolysis Severity of Acute Leg Ischemia Category Description Capillary return Muscle Paralysis Sensory Loss Doppler Signals Arterial Venous I Viable Not immediately threatened Intact None None Audible Audible IIa Threatened Salvageable if treated Intact/slow None Partial Inaudible Audible IIb Threatened Salvageable if treated as emergency Slow/ absent Partial Partial Inaudible Audible III Irreversible Primary amputation frequently required Absent Complete Complete Inaudible Inaudible Advantage of CDT: Gradual low pressure reperfusion; Underlying lesion identified Gardiner GA, Salvage of occluded bypass grafts by means of thrombolysis.J Vasc Surg 1989;9426-431 Case 1 Chen， F，72y Rest pain last for 6 Days No arterial fibrillation Claudication nearly 2 years Lower skin temperature Dark purple colour Toe and ankle paralysis Case 1 --Thrombolysis D0 Thrombolysis PTA – Sterling 4x120 CDT- Unifuse 5F50cm UK 30,000/h Case 1- Thrombolysis D2 Thrombolysis PTA- Coyote 2.5x100 Stent- Pulsar 4x80 The amount of UK 1120k Case 2 Fang, Male, 82y Rest pain 14D TIA(2 years ago); R ABI 0, L ABI 0.98 R renal artery stenosis 50% R caro