Catheter-directed Thrombolysis And Stenting Implantation In The Treatment Of Iliac Artery Thrombosis

Objectives:Peripheral arterial disease(PAD)often leads to artery which supplies blood to the lower limb stenosis or occlusion,for lower limb,PAD commonly occurs in iliac artery and the incidence increased with age.At the age of 50 or more people,the incidence of PAD is more than 10%.The most severe clinical manifestations of PAD are critical limb ischemia(CLI)and acute limb ischemia(ALI),and often associate with the risk of cardiovascular events.No matter PAD patients have clinical symptoms or not,PAD is the important predictor for cardiovascular disease(CVD)events and mortality.Currently,the main clinical symptoms of ALI and CLI are intermittent claudication and severe rest pain,some patients even suffered tissue necrosis.The PAD is mainly treated by open surgery or treatment of endovascular revascularization,and there was almost no other treatment in routine clinical practice.For patients who cannot sustain surgery,they can relieve symptoms only with drugs.Now there are a number of problems with management strategy of iliac arterial thrombosis,only 10% patients had typical claudication symptoms,giving huge challenges to early diagnosis of patients.At the same time many iliac arterial thrombosis patients underwent supracricoid laryngectomy with reconstruction of blood supply of repeated attempts,but eventually still need amputation.Early diagnosis and treatment and individualizedtreatment is the urgent needs for iliac arterial thrombosis to strengthen management.In this paper,we discussed and analyzed the safe and effective treatment of the iliac arteriosclerosis secondary acute thrombogenesis,and explored the factors influencing the curative effect and increasing the post-operational complications.Methods:We collected 136 cases in the vascular surgery department of the China-Japan Friendship Hospital Affiliated Jilin University from June2013 to December 2015,and retrospectively analyzed the 136 cases who suffered from iliac arteriosclerosis secondary acute thrombogenesis.According to the process of diagnosis and treatment of iliac arterial thrombosis occlusion,relevant inspection were carried on those patients.We distinguished the source of thrombi and excluded the contraindication,in addition,it is also necessary to be clear whether the limb had a large area of necrosis.We asked patients to take aspirin 300 mg + clopidogrel hydrogen 75 mg orally before the surgery.Then we chose the piercing road according to the patient condition(the brachial artery and/or femoral artery)as an incision access to conduct iliac artery angiography and conducted catheter-directed thrombolysis on the lesion blood vessel.After local impact urokinase thrombolysis,the patients returned to the ICU and were implemented the whole body heparinization,regularly reviewed the blood coagulation and maintained the APTT in 60-80 s.Thenmonitored fibrinogen level of 100 mg/dL or higher,and at the same time,gave urokinase(500000 units / 12 h)by continuous trace pump.Indwelling thrombolysis 12-48 hours,after the ischemic symptoms improved,we conducted secondary imaging,and then used stent implantation when opened the dissolved thrombus occlusion and gave regulating recheck after the surgery.We collected the ABI value after preoperative and the postoperative patency rate,etc.Then we analyzed the mortality,complications,and flow condition,and discussed related factors of the efficacy of intraoperative and postoperative effects.Results:Of all the 136 patients,4 cases underwent open surgery,and the technical success rate was 97.06%,in addition,there was no death of the technical-successful cases;of all the 132 technical-success cases,there were 47 cases whose TASC II level were lower than the CDT,and a total of 170 pieces of stents were implanted.116 patients with rest pain,of which 108 cases were relieved or disappeared,the remaining 8 patients got relief after femoral popliteal artery bypass surgery;3 cases of patients with successful early thrombosis,again after DCT lumen patency,long-term(12 months)new 7 cases between the stenosis and occlusion.After the surgery,the clinical symptoms of all patients were remitted;the perioperative complications was 6.76% and the six-month patency rate was 97.7%,the twelve-month patency rate was 94.7% which was higherthan the literature reported(iliac artery stent patency rate was from83.0% to 93.6% in 12 months).SPSS21.0 software were used to analyze the ABI value of the 136 patients.The results showed that the ABI value of the affected limbs were raised from 0.56 + /-0.11 to 0.99 + /-0.09,and the difference between postoperative limb group and preoperative limb group was statistically significant(p = 0.000 < 0.05).Conclusions:Acute thrombosis of iliac artery catheter thrombolysis must be distinguished with arterial embolization before stent implantation,exclude relative contraindications,open blood supply as soon as possible.Although urokinase has no difference with rt PA in terms of amputation rate,urokinase is safer and our department routine used urokinase;iliac arterial thrombosis,we conducted CDT and then conducted stent implantation.The patency rate after surgery has no significant difference compared with the traditional open surgery,in addition,it has the advantage of little trauma,quick recovery,high success rate and small risk during the perioperation,so the type of this surgery can be used as the first choice for such patients.