Evaluation of Catheter-Directed Thrombolysis for Acute Deep Vein Thrombosis / 日本心臓血管外科学会雑誌

We report the efficacy of catheter-directed thrombolysis (CDT) for acute deep vein thrombosis. Between January 2003 and August 2004, 20 patients were treated with CDT for occlusive femoral, ilio-femoral and vena caval thrombosis, for less than 2 weeks from onset. Average age was 56.4 years (range 30-78 years), 11 patients were male, and the duration of leg symptoms was 4.4 days (range 1-12 days). Routine temporary inferior vena caval filters were used, and a multi-lumen catheter was inserted from the popliteal vein. Urokinase was used via the catheter by the combination drip infusion method and pulse-spray method. All patients received heparin and stasis of venous flow was prevented with intermittent pneumatic compression. If thrombus remained, mechanical thrombolysis was necessary. Metallic stents were implanted for iliac vein compression syndrome and organized thrombus. Venographic severity score (VS score) and extremity circumference were used to evaluate the effects of treatment. The duration of the treatment was 5.0±0.28 days (range 2-9 days) and the total dosage of urokinase was 1, 025, 000±57, 000 units (range 360, 000-1, 680, 000 unit). One (5%) iliac vein compression syndrome and two (10%) organized thrombi were treated by implanted metallic stents. Giant thrombi was captured by temporary inferior vena caval filters in two patients, but there was no pulmonary embolism. Two patients had thrombophilia, one was antiphospholipid syndrome and one was protein S deficiency. There was an early recurrence in one patient and re-CDT was needed. The VS score deteriorated to 6.2±2.5 (post CDT) significantly (<i>p</i><0.0001) from 26.2±6.3 (pre CDT). CDT for acute deep vein thrombosis was effective and its early outcome was acceptable.

Experience of Popliteal Arterial Aneurysm / 日本心臓血管外科学会雑誌

In general the incidence of peripheral arterial aneurysm is said to be low. We focussed on popliteal aneurysm and enrolled 18 legs in 14 patients with popliteal aneurysm who visited us during the period from 1974 to January 1998 in our study. Acute arterial occlusion was observed as a complication in 6 of the 14 patients (42.9%) and rupture developed in 4 patients (28.6%), and on those occasions this disease was frequently detected and treated for the first time. Although this disease is said to scarcely affect prognosis, we encountered patients for whom amputation of the leg was unfortunately required. This disease was thus considered to require sufficient care. Popliteal arterial aneurysm is frequently palpable from the body surface and increased recognition of this disease should enable more appropriate treatment.

The Role of Systemic Inflammatory Response Syndrome for Acute Arterial Occlusion of the Lower Limb / 日本心臓血管外科学会雑誌

Reperfusion injury occasionally occurred after revasculization of acute arterial occlusion (AAO). The most common reason of death is myonephropatic metabolic syndrome due to reperfusion injury. This paper focusses on the criterion of systemic inflammatory response syndrome (SIRS). From January 1987 to April 1996, we treated 89 patients (male 59/female 30) with lower limb AAO. The mean age was 68.5 (ranging from 16 to 94) years old. There were 59 cases of thrombosis, 25 of embolism, 2 trauma and 3 dissecting aneurysm of the aorta. These patients were divided into two groups according to whether or not they fulfilled the criterion of SIRS. Of these patients, 46 cases met the criterion of SIRS (SIRS group) but the other 43 did not (non-SIRS group). We compared the two groups. The mortality of the SIRS group (23.9%) was higher than the non-SIRS group (2.3%). The ischemic time of the SIRS group (83.1±113.3 hours) was longer than the non-SIRS group (37.5±38.2 hours). Complications of MNMS were more common in the SIRS group (15.3%) than in the non-SIRS group (2.3%). The ischemic area in the SIRS group was remarkably less than in the non-SIRS group. Conclusion: The criterion of SIRS as indicated by the measurement of interleukin 8 (IL-8) was a useful prognostic parameter for limb salvage rate and mortality of AAO patients.

The Role of Leukocytes in Reperfusion Injury Following Acute Arterial Occlusion of the Lower Extremities / 日本心臓血管外科学会雑誌

<b>Purpose</b>. To determine the involvement of leukocytes in reperfusion injury following acute arterial occlusion of the lower extremities, the effect of leukocyte removal filters or leukotrien B4 (LTB4) antagonist was investigated using a canine acute arterial occlusion model. <b>Methods</b>. Twenty-eight mongrel dogs, weighing 15 to 20kg, underwent temporal occlusion of the infrarenal aorta and lumbar arteries followed by release of occlusion 12 hours later. Experimental groups consisted of the three following groups: Group I (<i>n</i>=12; control), dogs without any treatment; Group II (<i>n</i>=8), dogs treated with leukocyte removal filters from the onset of reperfusion until one hour after reperfusion; and Group III (<i>n</i>=8), dogs pretreated with LTB4 antagonist immediately before reperfusion. Serum myoglobin, CPK, and GOT were measured and compared among the three groups. <b>Results</b>. Values of serum myoglobin, CPK, and GOT, were significantly elevated after reperfusion in Group I as compared to those before reperfusion. However, increase in these values was significantly elevated after reperfusion in Group I as compared to those before reperfusion. However, increase in these values was significantly attenuated in Group II and Group III as compared to Group I. <b>Conclusions</b>. These data suggested leukocyte depletion injury following acute arterial occlusion of the lower extremities. Leukocytes appear to play a significant role in this type of reperfusion injury.