Objective To compare the efficacy and safety of surgical thrombectomy with those of catheter-directed thrombolysis (CDT) in treating acute lower limb ischemia (ALLI) . Methods The clinical data of 107 patients with ALLI, who underwent CDT or surgical thrombectomy at authors' hospital during the period from January 2012 to December 2017, were retrospectively analyzed. The incidence of complications, mortality, re-intervention rate and amputation rate within 30 days after operation were calculated. Cooley standard of efficacy score was used to assess the clinical curative effect of patients with grade Ⅱ of American Society of Vascular Surgeons (SVS) and International Society of Cardiovascular Surgery (ISCVS) classification of acute limb ischemia. Results A total of 107 patients with ALLI were enrolled in this study. Among them, 59 patients received CDT therapy and 48 patients received surgical thrombectomy. The technical success rate of both groups was 100％. Within 30 days after operation, the incidence of complications in CDT group and surgical thrombectomy group was 11.9％ and 14.6％ respectively, the mortality was 5.1％ and 6.3％respectively, and the re-intervention rate was 17.0％ and 22.9％ respectively, all the differences were not statistically significant (P>0.05) . The amputation rate of patients with grade Ⅱ of SVS/ISCVS ischemia classification in CDT group was 8.9％, which was higher than 2.3％ in surgical thrombectomy group, but the difference between the two groups was not statistically significant (P>0.05) . In patients with grade Ⅱ of ischemia assessed by the ca uses and Cooley curative effect standard at the time of discharge, the cure percentage of embolism-caused ALLI patients in surgical thrombectomy group was 82.5％, which was remarkably higher than 62.8％ in CDT group (P <0.05) . The cure percentage of thrombosis-caused ALLI patients in CDT group was 92.3％, which was strikingly higher than 25.0％ in surgical thrombectomy group (P <0.05) . The difference in the improvement of ischemia, which was assessed by the duration of ischemia and Cooley therapeutic criteria at the time of discharge, between the two groups was not statistically significant (P>0.05) . Conclusion In treating ALLI, no significant differences in curative effect, incidence of postoperative complications and mortality exist between surgical thrombectomy and CDT. The formulation of therapeutic regimen should be based on ischemia grade of SVS/ISCVS, etiology and coexisting underlying diseases.%目的 比较股动脉切开取栓和导管接触溶栓 (CDT) 治疗急性下肢缺血 (ALLI) 的有效性和安全性.方法 回顾性分析2012年1月至2017年12月采用切开取栓或CDT治疗的ALLI患者临床资料.评估术后30 d内并发症发生率、死亡率、再干预率及截肢率.Cooley疗效标准评估美国血管外科协会 (SVS) /国际心血管外科学会 (ISCVS) 急性肢体缺血分级为Ⅱ级患者临床效果.结果 共纳入患者107例, 其中59例接受CDT, 48例接受切开取栓治疗.两组技术成功率均为100％.CDT组、切开取栓组患者术后30 d内并发症发生率 (11.9％对14.6％) 、死亡率 (5.1％对6.3％) 、再次手术干预率 (17.0％对22.9％) 差异均无统计学意义 (P>0.05);CDT组SVS/ISCVS缺血分级为Ⅱ级患者截肢率高于切开取栓组, 但差异无统计学意义 (8.9％对2.3％, P>0.05) .根据病因和Cooley疗效标准评估缺血分级Ⅱ级患者出院时下肢缺血改善情况, 动脉栓塞患者痊愈比例在切开取栓组大于CDT组 (82.5％对62.8％, P<0.05), 血栓形成患者痊愈比例在CDT组大于切开取栓组 (92.3％对25.0％, P<0.05);根据缺血时间和Cooley疗效标准评估患者出院时缺血改善情况, 两组差异无统计学意义 (P>0.05) .结论 切开取栓、CDT两种术式治疗ALLI效果、术后并发症发生率和死亡率差异均无统计学意义.应根据患者SVS/ISCVS缺血分级、病因及伴有基础疾病制定治疗方案.
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