경희대학교
의과대학 외과학교실
김도균·박호철·고영관·고석환·주흥재
Treatment
of Acute Arterial Thromboembolism
Do-Kyun
Kim, M.D, Ho-Chul Park, M.D, Young-Gwan Ko, M.D,
Suck-Hwan Koh, M.D, Hoong-Zae Joo,
M.D.
Department
of Surgery, Kyunghee University School of Medicine
Background:
Arterial emboli remain an important cause of acute arterial ischemia. Despite simplification
of operative techniques, the substantial morbidity and mortality still associated
with an acute embolus remain a challenge to the vascular surgeon. We wanted to know
the adequate evaluation and treatment modality for this limb threatened condition,
and to evaluate the result according to etiology, location, time interval before
starting treatment, clinical conditions, and limb survival rate.
Material
and Methods: A retrospective review was conducted 91 patients who treated for acute
lower leg thromboembolism between Jan. l992 and Dec. l997.
Results:
There were 73 men and 18 women and most prevalent age group was in the 5th and 6th
decades (53.8%). Over all amputation rate was 25.3% and mortality rate was 5.5%,
Cardiac problem was most conmmon etiologic factor. Associated diseases were cardiac
problem (37.4%), hypertension(35.2%), cerebrovascular accident (l7.6%), and diabetes
(l5.4%). Interval from attack to definite therapy, within 24 hours in l4 cases (l5.4%),
l-3 days in 23 (25.3%), after 4 days in 54 (59.3%) were noted. The locations were
aorta and iliac in 25.3%, femoral in 38.5%, popliteal in l9.8%, tibial jn 4.4%,
and l5.4% in graft site in other of frequency. Clinical categories were grade I
in 9.9%, IIa in 40.7%, IIb in 30.8%, and III in l8.7%. According to Eagle's criteria,
low risk group were 34 cases (37.4%), moderate risk group were 39 cases (42.9%),
and high risk group were l8 cases (l9.8%). Of the 91 patients, conservative treatment
in 2 (2.2%), thrombolytic therapy in 33 (36.3%), thromboembolectomy in 56(61.5%),
bypass in 16 (17.6%), endarterectomy and vessel ligation were perfomed. The 1 month
and 1 year limb salvage rates were 73.4% and 71.1%, respectively. Especially, salvage
rates in the Department of Vascular Surgery were 84.9% and 83.7%, whereas that of
Thoracic and Orthopedic Surgery were 44.4% and 33.0% (p=0.0001).
Conclusions
: Cardiac problem especially atrial fibrillatioin was the most common etiologic
factor. Prompt ballon catheter embolectomy perfomed under local anesthesia is a
safe, simple, and effective method of treatment and the preferred mode of management
in the great majority of patients. Nonoperative management with thrombolytic agents
or high-dose heparin therapy alone is occasionally indicated in highly selected
patients. The prognosis of acute arterial thromboembolism of lower extreamity can
be improved by early detection, early adequate treatment, and the involvement of
a qualified vascular surgeon.
Key
Words : Thromboembolism, Acute arterial occlusion, Thromboembolectomy |
