Kakkos Stavros K, Haddad Joseph A, Haddad Georges K
Division of Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI 48202, USA.
J Vasc Access. 2010 Jan-Mar;11(1):8-11. doi: 10.1177/112972981001100102.
Previous studies have shown that stenosis of the arterial anastomosis of thrombosed hemodialysis (HD) grafts, unmasked after conventional thrombectomy, very often necessitate subsequent arterial angioplasty. The aim of this study was to describe a novel fluoroscopic-assisted balloon thrombectomy technique which permits simultaneous arterial angioplasty (should this is required) for thrombosed HD grafts.
Thirty patients with 36 thrombotic episodes of their prosthetic HD grafts participated in this study. A balloon angioplasty catheter is placed beyond the arterial anastomosis, over a guidewire; the balloon is inflated with contrast solution under fluoroscopy and pulled back to remove the arterial thrombus from the anastomosis. Any coexisting stenosis revealed by balloon indentation is completely dilated at that time, rather than after the thrombectomy. Mechanical thrombolysis of the graft and venous outflow is then performed with the AngioJet catheter (Possis Medical, Inc).
Technical and clinical success rates (the latter defined as one subsequent HD session) of the procedure were 100% and 94%, respectively. No complications, including arterial embolism, vessel rupture or pulmonary embolism, were encountered. Primary assisted patency at 3 and 6 months was 51% and 32%, respectively, while functional secondary patency at the same follow-up points was 78%.
Our technique is safe and also effective in both short- and long-term follow-up. Because it offers convenience, since the treatment of arterial anastomotic stenoses is accomplished in one (rather than two) steps, this method deserves further investigation.
既往研究表明，血栓形成的血液透析（HD）移植物动脉吻合口狭窄在传统血栓清除术后暴露出来，通常需要随后进行动脉血管成形术。本研究的目的是描述一种新型的透视辅助球囊血栓清除技术，该技术允许对血栓形成的HD移植物同时进行动脉血管成形术（如果需要的话）。
30例人工HD移植物发生36次血栓形成事件的患者参与了本研究。将球囊血管成形术导管置于动脉吻合口远端，越过导丝；在透视下用造影剂充盈球囊并回撤，以清除吻合口处的动脉血栓。球囊压迹显示的任何并存狭窄在此时而非血栓清除术后完全扩张。然后用AngioJet导管（Possis Medical公司）对移植物和静脉流出道进行机械溶栓。
该手术的技术成功率和临床成功率（后者定义为随后进行一次HD治疗）分别为100%和94%。未发生包括动脉栓塞、血管破裂或肺栓塞在内的并发症。3个月和6个月时的初次辅助通畅率分别为51%和32%，而在相同随访点的功能性二次通畅率为78%。
我们的技术在短期和长期随访中均安全且有效。由于该技术提供了便利，因为动脉吻合口狭窄的治疗可在一个（而非两个）步骤中完成，所以该方法值得进一步研究。
