상지 동맥의 급성 혈전색전증

Abstract

Purpose: Acute, ischemia of the arm is uncommon compared with events in the leg and much less attention has been paid to the management of acute arterial thromboembolism of the upper extremities. The aim of this study was to evaluate the clinical aspects and treatment outcomes of acute upper extremity thromboembolism. Methods: From January 2007 to March 2010, seven patients underwent the management of upper extremity thromboembolism in three Seoul National University (SNU)-affiliated hospitals. We retrospectively reviewed the medical records. Results: The mean age was 64.6 years (range 48 similar to 93 years) and 4 patients (57.1%) were female. Distribution of the thromboembolism were 4 in brachial, 1 in axillary plus brachial, 1 in ulnar and radial, and 1 in axillary artery, respectively. Time from symptom onset to presentation was 3.5 days (range 1 similar to 10 days). Primary treatment modality were Fogarty catheter embolectomy in 3 cases, bypass surgery in 1 case, and urokinase thrombolysis in 2 cases. A patient without symptoms was treated conservatively. Patients receiving primary thrombolytic therapy underwent surgical approach due to recurred thromboembolism during admission. In our 11.2 months of mean follow-up, there was recurrence but 1 patient died from cerebral infarction after 1.5 year of discharge. Conclusion: In this study, functional outcome of acute upper extremity ischemia following appropriate treatments was excellent. Key features of treatment are shortening the time interval of diagnosis to primary treatment, proper anticoagulation, and treatment of underlying conditions. Larger-volume, long-term results and meta-analysis of upper extremity thromboembolism are required to establish standardized treatment in Korea. 급성 상지 동맥 혈전색전증은 드문 질환이며 하지 동맥혈전색전증에 비하여 1/4 정도의 낮은 빈도로 발생한다고 보고되고 있다.(1)상지 통증이나 창백, 맥박소실, 감각 이상, 마비 등의 급성 동맥폐색의 전형적인 증상을 호소하게 되며, 확진이 되면 빠른 시간 내에 중재적 시술 또는 수술을 필요로 하는 외과적 응급 질환이다. 그러나, 상지 동맥 혈전색전증은 발생 빈도가 낮기 때문에 환자가 내원하여 증상을 호소하는 초기 진료 단계에서 이 질환의 감별진단을 내리기가 쉽지 않고, 이로 인해 적절한 진단 방법의 선택이나 치료가 지연될 수 있다.(2)국내에서는 증례 보고 형식의 일부 보고만 있어 왔고,(3)외국에서도 수술적 또는 중재적 치료 이후의 장기적인 생존율이나 재발에 대한 연구가 이루어진 바가 거의 없는 실정이다. 저자들은 3개 병원 외과에서 경험한 급성 상지 동맥 혈전색전증에 대한 증례들의 임상양상, 치료 및 결과를 분석하여 향후 치료 지침을 확립하는데 도움이 되고자 본 연구를 시행하였다.