Ito Yutaka, Sato Takashi, Okada Rei, Nakamura Nobumasa, Kimura Keiko, Takahashi Ryo, Miwa Naofumi, Sakurai Hiroshi, Tsuboi Masato, Kasuga Hirotake
Department of Internal Medicine, Nagoya Kyoritsu Hospital, Nagoya, Japan.
J Vasc Access. 2011 Jan-Mar;12(1):63-6. doi: 10.5301/jva.2010.5983.
Endovascular treatment (ET) is widely used for thrombotic complications of vascular access (VA) for hemodialysis. We evaluated the effectiveness of both ET and surgical interventions for thrombotic complications.
We studied 533 patients who underwent surgical procedures (a total of 879 procedures) and 54 patients who received ET (a total of 156 procedures) for VA obstruction (endovascular group; group 1). The 533 patients who underwent surgical procedures were further divided into two groups: the surgical balloon-angioplasty group (the thrombus was surgically removed and the stenotic lesions were dilated by balloon angioplasty; 189 procedures; group 2) and the surgical repair group (the stenotic lesions were bypassed with additional graft diversion or creation of a new access; 690 procedures; group 3). The three groups were evaluated for VA patency.
Using the Kaplan-Meier method, the 2-yr patency for groups 1, 2, and 3 were 11.1%, 11.5%, and 34.0% (p<0.0001). The 2-yr patency rates in patients in whom arteriovenous grafts were used were 5.9% (group 1), 9.2% (group 2), and 22.8% (group 3) (p<0.0001), whereas in patients with arteriovenous fistulae they were 33.7% (group 1), 35.7% (group 2), and 59.8% (group 3) (p=0.0005).
A surgical approach may cause difficulty in creating a new VA, because useful access vessels are limited. Our results indicate surgical balloon-angioplasty and ET provide the same patency. ET is less invasive and can be repeated, which makes it beneficial for the patients. We concluded ET could be considered as the first-line treatment for thrombotic complications.
血管内治疗（ET）广泛应用于血液透析血管通路（VA）的血栓形成并发症。我们评估了ET和手术干预对血栓形成并发症的有效性。
我们研究了533例行外科手术（共879例手术）的患者和54例接受ET治疗（共156例手术）的VA阻塞患者（血管内治疗组；第1组）。533例行外科手术的患者进一步分为两组：手术球囊血管成形术组（通过手术清除血栓并通过球囊血管成形术扩张狭窄病变；189例手术；第2组）和手术修复组（通过额外的移植分流或创建新的通路绕过狭窄病变；690例手术；第3组）。对三组的VA通畅情况进行评估。
采用Kaplan-Meier法，第1、2和3组的2年通畅率分别为11.1%、11.5%和34.0%（p<0.0001）。使用动静脉移植物的患者中，2年通畅率分别为5.9%（第1组）、9.2%（第2组）和22.8%（第3组）（p<0.0001），而在动静脉内瘘患者中，分别为33.7%（第1组）、35.7%（第2组）和59.8%（第3组）（p=0.0005）。
手术方法可能难以创建新的VA，因为可用的血管通路有限。我们的结果表明，手术球囊血管成形术和ET的通畅率相同。ET侵入性较小且可重复，这对患者有益。我们得出结论，ET可被视为血栓形成并发症的一线治疗方法。
