Moossavi Shahriar, Regan John D, Pierson Eric D, Kasey John M, Tuttle Audrey B, Vachharajani Tushar J, Bettmann Michael A, Russell Gregory B, Freedman Barry I
Department of Internal Medicine, Wake Forsest University School of Medicine, Winston-Salem, North Carolina 27157-1053, USA.
Semin Dial. 2007 Sep-Oct;20(5):459-64. doi: 10.1111/j.1525-139X.2007.00356.x.
Attempts to salvage thrombosed hemodialysis arterio-venous fistulae (AVF) using interventional techniques are not universally performed. Patients often require temporary dialysis catheters pending creation of a new vascular access. We determined the long-term outcome of interventional (non-surgical) repair of completely thrombosed AVF in 49 consecutive accesses (22 radio-cephalic, 1 radio-basilic, 19 brachio-cephalic, and 7 brachio-basilic) referred for an intervention within 48 hours of thrombosis. Subjects were 65% male (32), with mean +/- SD age 63.7 +/- 13.5 years (range 33-91), 51% African-American (25), 47% Caucasian (23) and 65% had diabetes (32). Overall, 96% (47/49) of thrombosed AVF were salvaged with complications observed in four cases (two extravasations of contrast; two radial artery emboli), with no serious long-term sequelae. Interventional procedures included 34 venous angioplasties, 11 venous angioplasties with stenting and two combined venous and arterial angioplasties. The primary and secondary patency rates for all salvaged AVF were 50.5 +/- 8.7%, 72.5 +/- 7.8% at 1 year, and 43.3 +/- 10%, 55.4 +/- 12.7% at 2 years, respectively. The median estimate to first intervention after the declot procedure was 14.7 months. The median estimate for continued function exceeded 23.1 months. There was no significant statistical difference in the primary (p = 0.73) and secondary patency rates (p = 0.057) for forearm vs. upper arm AVF. We conclude that interventional repairs should routinely be employed to salvage newly thrombosed AVF. The vast majority of these individuals can avoid receiving dialysis catheters or placement of a new dialysis vascular access.
使用介入技术挽救血栓形成的血液透析动静脉内瘘（AVF）的尝试并非普遍开展。患者在建立新的血管通路之前通常需要临时透析导管。我们确定了49例连续血栓形成的AVF进行介入（非手术）修复的长期结果（22例桡动脉-头静脉，1例桡动脉-贵要静脉，19例肱动脉-头静脉，7例肱动脉-贵要静脉），这些患者在血栓形成后48小时内接受了介入治疗。受试者中65%为男性（32例），平均年龄±标准差为63.7±13.5岁（范围33 - 91岁），51%为非裔美国人（25例），47%为白种人（23例），65%患有糖尿病（32例）。总体而言，96%（47/49）的血栓形成的AVF得以挽救，4例出现并发症（2例造影剂外渗；2例桡动脉栓塞），无严重长期后遗症。介入手术包括34例静脉血管成形术、11例带支架的静脉血管成形术和2例动静脉联合血管成形术。所有挽救的AVF的初次通畅率和二次通畅率在1年时分别为50.5±8.7%、72.5±7.8%，在2年时分别为43.3±10%、55.4±12.7%。血栓清除术后至首次干预的中位估计时间为14.7个月。持续功能的中位估计时间超过23.1个月。前臂与上臂AVF的初次通畅率（p = 0.73）和二次通畅率（p = 0.057）无显著统计学差异。我们得出结论，应常规采用介入修复来挽救新形成血栓的AVF。这些患者中的绝大多数可以避免接受透析导管或放置新的透析血管通路。
