Van Ha Thuong
Radiologist, Department of Radiology Section of Vascular and Interventional Radiology, The University of Chicago, Chicago, Illinois.
Semin Intervent Radiol. 2004 Jun;21(2):77-81. doi: 10.1055/s-2004-833680.
This article reviews current concepts in the percutaneous management of thrombosed polytetrafluoroethylene (PTFE) dialysis access grafts. The maintenance of dialysis access grafts remains a challenging task. Graft surveillance is critical in the prevention of graft thrombosis to prolong graft survival. Once a graft is thrombosed, surgical and percutaneous options are available for restoration of flow. There has been an evolution in the percutaneous treatment of thrombosed dialysis access grafts during the last 20 years, with refinement of pharmacomechanical techniques, allowing for safe and efficacious restoration of flow in thrombosed grafts. There has been emergence of alternative thrombolytic agents to urokinase, which was withdrawn from the United States in late 1998 and recently reintroduced. These alternative thrombolytic agents have similar outcomes compared with urokinase, with the additional advantage of being less expensive. In addition, several mechanical devices, which were popular briefly when urokinase was unavailable, are available currently for use within grafts, with similar success, although their prices have limited widespread use.
本文综述了聚四氟乙烯（PTFE）透析通路移植物血栓形成的经皮处理的当前概念。透析通路移植物的维护仍然是一项具有挑战性的任务。移植物监测对于预防移植物血栓形成以延长移植物存活至关重要。一旦移植物发生血栓形成，手术和经皮治疗方法都可用于恢复血流。在过去20年中，血栓形成的透析通路移植物的经皮治疗有了进展，药物机械技术得到改进，使得血栓形成的移植物能够安全有效地恢复血流。除了1998年末从美国撤出但最近又重新引入的尿激酶之外，还出现了其他溶栓剂。这些替代溶栓剂与尿激酶相比有相似的疗效，还有价格较低的额外优势。此外，在尿激酶无法获得时曾短暂流行的几种机械装置，目前可用于移植物内，成功率相似，尽管其价格限制了广泛应用。
