Manninen Hannu I, Kaukanen Erkki, Mäkinen Kimmo, Karhapää Pauli
Department of Clinical Radiology, Kuopio University Hospital and Kuopio University, Puijonlaaksontie 2, FI-70210 Kuopio, Finland.
J Vasc Interv Radiol. 2008 Jun;19(6):870-6. doi: 10.1016/j.jvir.2008.02.024. Epub 2008 Apr 10.
To evaluate the utility of endovascular salvage of nonmaturing autogenous hemodialysis fistulas in a prospective trial of consecutive patients compared with a historical group of patients who underwent treatment of failing mature autogenous fistulas.
During a 12-year period, angiography revealed anatomic lesions in 75 fistulas with maturing problems (72 radiocephalic and three brachiocephalic). Endovascular therapy through antegrade arterial access was attempted in 72 fistulas. A series of 45 consecutive patients who underwent endovascular salvage of failing mature fistulas was used as a control group.
A technical success rate of 88% (66 of 75) and a clinical success rate of 87% (65 of 75) were achieved for the nonmaturing fistulas. Including the secondary interventions, the rate of complications was 6.1% (eight of 131). By Kaplan-Meier analysis, the primary clinical patency rates were 43% +/- 6% (+/-SEM), 36% +/- 6%, and 23% +/- 6%, and the secondary patency rates were 76% +/- 5%, 68% +/- 6%, and 57% +/- 8% at 6, 12, and 36 months, respectively. A small inflow artery (<3 mm in diameter) predicted a poorer primary patency rate (28% +/- 10% vs 48% +/- 9% at 1 year; P = .01). The secondary patency rate of nonmaturing fistulas at 3 years was worse than that of mature fistulas, at 57% +/- 8% versus 79% +/- 8% (P = .02).
A functional fistula was achieved in 87% of nonmaturing fistulas. Although the functional time gained in these fistulas is shorter than that gained in failing mature fistulas, more than half of nonmaturing fistulas are functional after 3 years.
在一项针对连续患者的前瞻性试验中，评估血管内挽救未成熟自体动静脉内瘘的效用，并与一组接受失败成熟自体动静脉内瘘治疗的历史患者进行比较。
在12年期间，血管造影显示75例存在成熟问题的内瘘（72例桡动脉-头静脉内瘘和3例肱动脉-头静脉内瘘）有解剖学病变。对72例内瘘尝试通过顺行动脉入路进行血管内治疗。将连续45例接受失败成熟内瘘血管内挽救治疗的患者作为对照组。
未成熟内瘘的技术成功率为88%（75例中的66例），临床成功率为87%（75例中的65例）。包括二次干预在内，并发症发生率为6.1%（131例中的8例）。通过Kaplan-Meier分析，6个月、12个月和36个月时的初次临床通畅率分别为43%±6%（±标准误）、36%±6%和23%±6%，二次通畅率分别为76%±5%、68%±6%和57%±8%。小流入动脉（直径<3 mm）预示初次通畅率较差（1年时为28%±10%对48%±9%；P = 0.01）。未成熟内瘘3年时的二次通畅率低于成熟内瘘，分别为57%±8%对79%±8%（P = 0.02）。
87%的未成熟内瘘实现了功能性内瘘。尽管这些内瘘获得的功能时间短于失败成熟内瘘，但超过一半的未成熟内瘘在3年后仍具有功能。
