Sofocleous Constantinos T, Schur Israel, Koh Elsie, Hinrichs Clay, Cooper Stanley G, Welber Adam, Brountzos Elias, Kelekis Dimitris
Department of Radiology Vascular and Interventional, University of Medicine and Dentistry of New Jersey, University Hospital, C320 150 Bergen Street, Newark, NJ 07103-2406, USA.
Eur J Radiol. 2003 Sep;47(3):237-46. doi: 10.1016/s0720-048x(02)00087-6.
INTRODUCTION/OBJECTIVE: To describe and evaluate percutaneous treatment methods of complications occurring during recanalization of thrombosed hemodialysis access grafts.
A retrospective review of 579 thrombosed hemodialysis access grafts revealed 48 complications occurring during urokinase thrombolysis (512) or mechanical thrombectomy (67). These include 12 venous or venous anastomotic ruptures not controlled by balloon tamponade, eight arterial emboli, 12 graft extravasations, seven small hematomas, four intragraft pseudointimal 'dissections', two incidents of pulmonary edema, one episode of intestinal angina, one procedural death, and one distant hematoma.
Twelve cases of post angioplasty ruptures were treated with uncovered stents of which 10 resulted in graft salvage allowing successful hemodialysis. All arterial emboli were retrieved by Fogarty or embolectomy balloons. The 10/12 graft extravasations were successfully treated by digital compression while the procedure was completed and the graft flow was restored. Dissections were treated with prolonged Percutaneous Trasluminal Angioplasty (PTA) balloon inflation. Overall technical success was 39/48 (81%). Kaplan-Meier Primary and secondary patency rates were 72 and 78% at 30, 62 and 73% at 90 and 36 and 67% at 180 days, respectively. Secondary patency rates remained over 50% at 1 year. There were no additional complications caused by these maneuvers.
The majority of complications occurring during percutaneous thrombolysis/thrombectomy of thrombosed access grafts, can be treated at the same sitting allowing completion of the recanalization procedure and usage of the same access for hemodialysis.
引言/目的：描述和评估血栓形成的血液透析通路移植物再通期间发生的并发症的经皮治疗方法。
对579例血栓形成的血液透析通路移植物进行回顾性研究，发现在尿激酶溶栓（512例）或机械取栓（67例）过程中发生了48例并发症。这些并发症包括12例经球囊压迫无法控制的静脉或静脉吻合口破裂、8例动脉栓塞、12例移植物外渗、7例小血肿、4例移植物内假性内膜“夹层”、2例肺水肿、1例肠绞痛、1例手术死亡和1例远处血肿。
12例血管成形术后破裂病例采用裸支架治疗，其中10例成功挽救移植物，实现了成功的血液透析。所有动脉栓塞均通过Fogarty导管或取栓球囊取出。12例移植物外渗中的10例在手术完成且移植物血流恢复时通过指压成功治疗。夹层通过延长经皮腔内血管成形术（PTA）球囊扩张进行治疗。总体技术成功率为39/48（81%）。Kaplan-Meier一级和二级通畅率在30天时分别为72%和78%，90天时分别为62%和73%，180天时分别为36%和67%。1年时二级通畅率仍超过50%。这些操作未引起额外并发症。
血栓形成的通路移植物经皮溶栓/取栓过程中发生的大多数并发症可在同一次手术中得到治疗，从而完成再通程序并使用同一通路进行血液透析。
