Clinical application of ultrasound guided Fogarty balloon catheter in arterial crisis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Xiaodong ¹ ,  WANG Pei ¹ , YU Changyu ¹ , YAN Xiaowei ² , YIN Jing ³

1. Department of Hand and Foot Surgery, Chengde Medical College Affiliated Hospital, Chengde Hebei, 067000, P.R.China;
2. Department of Critical Care Medicine, Chengde Medical College Affiliated Hospital, Chengde Hebei, 067000, P.R.China;
3. Department of Vascular Surgery, Chengde Medical College Affiliated Hospital, Chengde Hebei, 067000, P.R.China;

Corresponding?author：

WANG Pei, Email: cdgkwp@qq.com

Keywords：

Color doppler ultrasonography; Fogarty balloon catheter; replantation of severed limb; arterial crisis

DOI：

10.7507/1002-1892.201705057

Video：

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Objective To explore the effectiveness of arterial crisis after replantation of limb treated by ultrasound guided Fogarty balloon catheter. Methods Between January 2012 and July 2016, 27 patients suffered from arterial crisis after replantation of limb were treated with ultrasound guided Fogarty balloon catheter combined with thrombolytic anticoagulant. There were 18 males and 9 females with the age of 19-51 years (mean, 32 years). The limb mutilation position was at knee joint in 3 cases, lower limb in 9 cases, ankle joint in 6 cases, elbow joint in 2 cases, forearm in 4 cases, and wrist joint in 3 cases. The arterial crisis happened at 2.5-18 hours (mean, 7.5 hours) after limb replantation surgery. Color doppler ultrasonography was used to diagnose the arterial thrombosis, finally the anastomotic thrombosis were found in 16 cases, non-anastomotic thrombosis in 7 cases, and combined thrombosis in 4 cases. All the thrombosis were deteced in the arteries with the length of 0.8-3.9 cm. Results No complication such as vascular perforation, rupture, air embolism, thromboembolism, wound infection, or sepsis happened after operation. Arterial crisis occurred again in 3 cases at 1.5-13.5 hours after limb replantation and treated by arterial exploration, 1 case was treated successfully; 2 cases had arterial occlusion and partial necrosis of limb, and got amputation treatment at last. The rest 24 cases survived with the incision healing by first stage. In the 24 cases, 1 case suffered from acute myonephropathic metabolic syndrome and corrected after hemodialysis; 1 case suffered from acute liver functional damage and corrected by comprehensive treatment of internal medicine. The 24 patients were followed up 7-38 months (mean, 11 months). At last follow-up, blood supply of the limb was good with normal skin temperature and improved sense of feeling, activity, and swelling. According to Chinese Medical Association of hand surgery to the upper extremity function assessment standard, the results were excellent in 12 cases, good in 8 cases, and fair in 4 cases with an excellent and good rate of 83.3%. Conclusion Ultrasound guided Fogarty balloon catheter treatment of posterior replantation of arterial crisis can accurately locate the thrombosis, get the thrombus fast and invasive minimally to avoid the blind and repeated thrombectomy, and obtain certain effectiveness.

Citation： LI Xiaodong, WANG Pei, YU Changyu, YAN Xiaowei, YIN Jing. Clinical application of ultrasound guided Fogarty balloon catheter in arterial crisis. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(10): 1220-1224. doi: 10.7507/1002-1892.201705057 Copy

1.	曾文超, 郭洪敏, 王洪賓, 等. 復雜肢體離斷再植的臨床治療體會. 實用骨科雜志, 2015, 21(2): 184-186.0.
2.	周喆剛, 萬圣祥, 肖穎鋒, 等. 游離皮瓣失敗病例的原因及臨床處理結果分析. 實用骨科雜志, 2016, 22(9): 802-805.0.
3.	潘生德, 顧玉東, 侍德. 中華醫學會手外科學會上肢部分功能評定試用標準. 中華手外科雜志, 2000, 16(3): 130-135.0.
4.	石健, 趙鋼, 程春生, 等. 前列地爾對皮瓣移植患者術后凝血系統的影響. 創傷外科雜志, 2016, 18(9): 560-562.0.
5.	Wong AK, Joanna Nguyen T, Peric M, et al. Analysis of the risk factors associated with microvascular free flap failure using a multi-institutional database. Microsurgery, 2015, 35(1): 6-12.
6.	唐軍, 張艷閣, 黃建瓊, 等. 下肢血管畸形的手術治療. 中國修復重建外科雜志, 2017, 31(5): 638-640.0.
7.	李小東, 劉士波, 嚴曉薇, 等. Fogarty球囊導管在斷肢再植術后動脈危象中的應用. 中國煤炭工業醫學雜志, 2017, 20(4): 409-412.0.
8.	曹樹偉, 張靜, 郭志勇, 等. 介入術聯合術后抗凝溶栓治療下肢深靜脈血栓形成效果觀察. 山東醫藥, 2016, 56(8): 54-56.0.
9.	黎宏莊, 游文霞, 李國興. SolitaireTMAB取栓與尿激酶靜脈溶栓治療急性顱內大動脈閉塞的效果比較. 廣東醫學, 2016, 37(7): 1060-1063.0.
10.	Desancho MT, Bardarova S, Chapin J. Adherence to guidelines for perioperte management of anticoagula-tion results in decreased bleeding complications: a single-centre experience. Blood Coagul Fibrinolysis, 2015, 26(4): 426-429.
11.	龔凱, 黃道景, 張亞明. 急性下肢缺血診治的臨床分析. 中國實用醫藥, 2017, 12(3): 14-16.0.
12.	鄭樹法, 莊勇, 余良宏, 等. 術中B超實時監測在幕上病變精準手術中的臨床應用. 福建醫科大學學報, 2015, 49(2): 131-135.0.
13.	程光森, 許衛國, 陳加源, 等. DSA監視下Fogarty球囊導管在急性肢體動脈栓塞中的應用. 實用放射學雜志, 2015, 31(8): 1348-1350.0.
14.	楊志, 林龍英, 王家興. Fogarty球囊導管在自體動靜脈內瘺取栓術中的應用. 中國血液凈化, 2016, 15(10): 576.0.
15.	劉建峰, 高金玲, 李輝, 等. Solitaire AB型支架取栓術治療急性大腦中動脈閉塞. 山東醫藥, 2016, 56(43): 15-18.0.
16.	張子龍, 張克難, 龐典付, 等. 多種無創性檢測指標與股腘動脈硬化閉塞癥病變程度的相關性分析. 福建醫科大學學報, 2016, 50(3): 186-191.0.
17.	丁杭, 韓濤, 程章波. 19例肢體假性動脈瘤臨床分析. 福建醫科大學學報, 2015, 49(3): 193-194.0.
18.	劉曉明, 向明, 車正蘭, 等. 彩色多普勒超聲評價自體動靜脈內瘺急性血栓形成中用Fogarty球囊導管取栓的臨床應用. 臨床超聲醫學雜志, 2016, 18(7): 488-490.0.
19.	徐新, 韓秋果, 劉巍立, 等. Fogarty導管取栓治療急性腸系膜上動脈栓塞的臨床療效及安全性. 中華普通外科雜志, 2016, 31(9): 787-788.0.
20.	Tall J, Bj?rklund TC, Skogh AC, et al. Vascular complications after radiotherapy in head and neck free flap reconstruction: Clinical outcome related to vascular biology. Ann Plast Surg, 2015, 75(3): 309-315.

1. 曾文超, 郭洪敏, 王洪賓, 等. 復雜肢體離斷再植的臨床治療體會. 實用骨科雜志, 2015, 21(2): 184-186.0.
2. 周喆剛, 萬圣祥, 肖穎鋒, 等. 游離皮瓣失敗病例的原因及臨床處理結果分析. 實用骨科雜志, 2016, 22(9): 802-805.0.
3. 潘生德, 顧玉東, 侍德. 中華醫學會手外科學會上肢部分功能評定試用標準. 中華手外科雜志, 2000, 16(3): 130-135.0.
4. 石健, 趙鋼, 程春生, 等. 前列地爾對皮瓣移植患者術后凝血系統的影響. 創傷外科雜志, 2016, 18(9): 560-562.0.
5. Wong AK, Joanna Nguyen T, Peric M, et al. Analysis of the risk factors associated with microvascular free flap failure using a multi-institutional database. Microsurgery, 2015, 35(1): 6-12.
6. 唐軍, 張艷閣, 黃建瓊, 等. 下肢血管畸形的手術治療. 中國修復重建外科雜志, 2017, 31(5): 638-640.0.
7. 李小東, 劉士波, 嚴曉薇, 等. Fogarty球囊導管在斷肢再植術后動脈危象中的應用. 中國煤炭工業醫學雜志, 2017, 20(4): 409-412.0.
8. 曹樹偉, 張靜, 郭志勇, 等. 介入術聯合術后抗凝溶栓治療下肢深靜脈血栓形成效果觀察. 山東醫藥, 2016, 56(8): 54-56.0.
9. 黎宏莊, 游文霞, 李國興. SolitaireTMAB取栓與尿激酶靜脈溶栓治療急性顱內大動脈閉塞的效果比較. 廣東醫學, 2016, 37(7): 1060-1063.0.
10. Desancho MT, Bardarova S, Chapin J. Adherence to guidelines for perioperte management of anticoagula-tion results in decreased bleeding complications: a single-centre experience. Blood Coagul Fibrinolysis, 2015, 26(4): 426-429.
11. 龔凱, 黃道景, 張亞明. 急性下肢缺血診治的臨床分析. 中國實用醫藥, 2017, 12(3): 14-16.0.
12. 鄭樹法, 莊勇, 余良宏, 等. 術中B超實時監測在幕上病變精準手術中的臨床應用. 福建醫科大學學報, 2015, 49(2): 131-135.0.
13. 程光森, 許衛國, 陳加源, 等. DSA監視下Fogarty球囊導管在急性肢體動脈栓塞中的應用. 實用放射學雜志, 2015, 31(8): 1348-1350.0.
14. 楊志, 林龍英, 王家興. Fogarty球囊導管在自體動靜脈內瘺取栓術中的應用. 中國血液凈化, 2016, 15(10): 576.0.
15. 劉建峰, 高金玲, 李輝, 等. Solitaire AB型支架取栓術治療急性大腦中動脈閉塞. 山東醫藥, 2016, 56(43): 15-18.0.
16. 張子龍, 張克難, 龐典付, 等. 多種無創性檢測指標與股腘動脈硬化閉塞癥病變程度的相關性分析. 福建醫科大學學報, 2016, 50(3): 186-191.0.
17. 丁杭, 韓濤, 程章波. 19例肢體假性動脈瘤臨床分析. 福建醫科大學學報, 2015, 49(3): 193-194.0.
18. 劉曉明, 向明, 車正蘭, 等. 彩色多普勒超聲評價自體動靜脈內瘺急性血栓形成中用Fogarty球囊導管取栓的臨床應用. 臨床超聲醫學雜志, 2016, 18(7): 488-490.0.
19. 徐新, 韓秋果, 劉巍立, 等. Fogarty導管取栓治療急性腸系膜上動脈栓塞的臨床療效及安全性. 中華普通外科雜志, 2016, 31(9): 787-788.0.
20. Tall J, Bj?rklund TC, Skogh AC, et al. Vascular complications after radiotherapy in head and neck free flap reconstruction: Clinical outcome related to vascular biology. Ann Plast Surg, 2015, 75(3): 309-315.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application of ultrasound guided Fogarty balloon catheter in arterial crisis

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