Department of Radiology, Division of Interventional Radiology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104, USA.
J Vasc Interv Radiol. 2011 Mar;22(3):317-24. doi: 10.1016/j.jvir.2010.11.021.
Percutaneous declotting is usually not offered for hemodialysis access grafts clotting < 30 days after placement because of concerns regarding safety of percutaneous transluminal angioplasty in fresh anastomoses, potential need for surgical correction of the underlying cause, and poor outcomes. The authors sought to determine acute and long-term outcomes of declotting of grafts with early failure.
Of 860 percutaneous mechanical thrombectomies performed between July 2001 and June 2007, 23 were performed in grafts < 30 days after initial placement. In addition, 16 percutaneous thrombectomies performed in grafts 31-60 days after placement were identified. Data collected included medical history, graft characteristics, immediate technical and clinical success, complications, and subsequent graft patency and survival. Kaplan-Meier analysis compared outcomes in grafts < 30 days (U30) versus those 31-60 days (U60) old.
There was no difference between the U30 and U60 groups in primary patency (13 vs 19 days, respectively, P = 0.17) or in postintervention access patency (38 vs 189 days, respectively, P = 0.63). A strong trend toward shorter secondary patency in U30 grafts was observed (17 vs 73 days, P = 0.06). Underlying lesions not amenable to percutaneous treatment were found in 62% of U30 grafts and 33% of U60 grafts (P = 0.18). Neither group achieved the K/DOQI Guidelines' recommended 85% technical success or 40% 90-day primary patency; in the U30 group it was 0% and in the U60 group 17%.
Percutaneous declotting of grafts yields poor outcomes, well below the K/DOQI threshold not only within 30 days but also within 60 days of placement.
对于放置后 <30 天的血液透析通路移植物血栓形成，通常不提供经皮溶栓治疗，因为担心在新鲜吻合口行经皮腔内血管成形术的安全性、潜在需要手术纠正根本原因以及不良结局。作者旨在确定早期失败的移植物溶栓的急性和长期结局。
在 2001 年 7 月至 2007 年 6 月期间进行的 860 例经皮机械血栓切除术，其中 23 例在初次放置后 <30 天进行。此外，还确定了 16 例在放置后 31-60 天进行的经皮血栓切除术。收集的数据包括病史、移植物特征、即刻技术和临床成功率、并发症以及随后的移植物通畅性和存活率。Kaplan-Meier 分析比较了 <30 天（U30）和 31-60 天（U60）的移植物之间的结局。
U30 组和 U60 组的初次通畅率（分别为 13 天和 19 天，P=0.17）或介入后通路通畅率（分别为 38 天和 189 天，P=0.63）无差异。观察到 U30 移植物的继发性通畅时间明显缩短趋势（17 天与 73 天，P=0.06）。62%的 U30 移植物和 33%的 U60 移植物发现无法进行经皮治疗的潜在病变（P=0.18）。两组均未达到 K/DOQI 指南推荐的 85%技术成功率或 40%90 天的初次通畅率；U30 组为 0%，U60 组为 17%。
经皮溶栓治疗移植物的结局较差，不仅在放置后 30 天内，而且在 60 天内，均远低于 K/DOQI 阈值。
