Clark Timothy W I, Haji-Momenian Shawn, Kwak Andrew, Soulen Michael C, Stavropoulos S William, Itkin Maxim, Patel Aalpen, Mondschein Jeffrey I, Trerotola Scott O
Section of Vascular and Interventional Radiology, Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY 10016, USA.
J Vasc Interv Radiol. 2009 Jan;20(1):61-5. doi: 10.1016/j.jvir.2008.09.024. Epub 2008 Nov 20.
To evaluate late angiographic changes at the puncture site with use of a suture lock device for hemostasis after hemodialysis access interventions.
Thirty-five patients who underwent percutaneous intervention of a failing or thrombosed access had 76 puncture sites (58 grafts, 15 fistulas, three composite) managed with a purse-string suture lock device. All patients had follow-up fistulograms available for analysis. Fistulograms at the site of sheath insertion were retrospectively compared with those obtained during subsequent hemodialysis access procedures to assess for changes in access lumen diameter. Access type, sheath size, and heparin dose were examined as predictors of access diameter change at the puncture site.
The mean time to follow-up fistulography was 4.7 months; the cumulative observation time of the patient cohort was 30.5 dialysis years. The mean change in access diameter at the previous puncture site was -0.3%. No puncture sites became aneurysmal or stenotic during follow-up. Two of the 76 puncture sites (both grafts) developed mild (+28%) and moderate (+43%) bulging at the sheath site. The remaining 74 puncture sites (97%) showed no significant change in access diameter. The mean change in access diameter among fistulas was -6.2%, and that among grafts was +1.5% (P = .06). Neither sheath size (P = .26) nor heparin dose (P = .48) had an effect on access diameter.
No patients developed aneurysms or stenosis at the puncture site after use of a suture lock device for hemostasis. This technique is consistent, safe, and effective in obtaining hemostasis after dialysis access interventions of fistulas and grafts.
使用缝线锁定装置对血液透析通路干预后的穿刺部位进行止血，并评估其血管造影晚期变化。
35例接受失败或血栓形成的通路经皮介入治疗的患者，其76个穿刺部位（58个移植物、15个动静脉内瘘、3个复合通路）采用荷包缝合锁定装置处理。所有患者均有可供分析的随访动静脉内瘘造影。回顾性比较鞘管插入部位的动静脉内瘘造影与后续血液透析通路操作期间获得的造影，以评估通路管腔直径的变化。将通路类型、鞘管尺寸和肝素剂量作为穿刺部位通路直径变化的预测因素进行研究。
随访动静脉内瘘造影的平均时间为4.7个月；患者队列的累积观察时间为30.5透析年。先前穿刺部位的通路直径平均变化为-0.3%。随访期间无穿刺部位形成动脉瘤或狭窄。76个穿刺部位中有2个（均为移植物）在鞘管部位出现轻度（+28%）和中度（+43%）隆起。其余74个穿刺部位（97%）的通路直径无明显变化。动静脉内瘘的通路直径平均变化为-6.2%，移植物的为+1.5%（P = 0.06）。鞘管尺寸（P = 0.26）和肝素剂量（P = 0.48）均对通路直径无影响。
使用缝线锁定装置进行止血后，无患者在穿刺部位发生动脉瘤或狭窄。该技术在动静脉内瘘和移植物的透析通路干预后止血方面是一致、安全且有效的。
