Section of Interventional Nephrology, Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
Clin J Am Soc Nephrol. 2011 Jun;6(6):1333-6. doi: 10.2215/CJN.09851110. Epub 2011 May 5.
The safety of percutaneous endovascular declotting procedures for thrombosed hemodialysis fistulae/grafts is well described in the general population; however, its safety in the presence of a patent foramen ovale (PFO) is not known. The objective of this study is to assess the incidence of symptomatic paradoxical embolic events associated with declotting procedure of thrombosed arteriovenous (AV) graft or fistula in patients with documented PFO.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a retrospective study in a hospital-based, academic practice. It included 23 patients (10 men; mean age, 65) with PFO and thrombosed hemodialysis graft/fistula who underwent a standardized declotting procedure with 2 mg of Alteplase and balloon thrombectomy. Twenty patients (87%) had AV grafts, and three (13%) had AV fistulae. The PFO shunt was right to left in two (9%), left to right in eight (34%), and bidirectional in ten (44%). The shunt direction was not specified in three patients (13%). The technical success of the declotting procedure and the frequency of clinically manifested paradoxical embolic events in this patient population were calculated.
Fifty declotting procedures were performed on 23 patients with a technical success rate of 96% (48 of 50, 96%). No symptomatic paradoxical embolic events were found in any of the 23 patients with PFO.
Symptomatic paradoxical embolic events after percutaneous endovascular declotting procedures of thrombosed AV grafts and fistulae in patients with documented PFO are rare. This procedure appears to be safe in patients with a PFO.
经皮腔内血管血栓切除术治疗血栓形成的血液透析瘘/移植物在普通人群中的安全性已有详细描述；然而，在卵圆孔未闭（PFO）存在的情况下其安全性尚不清楚。本研究的目的是评估经皮腔内血管血栓切除术治疗有记录的 PFO 患者血栓形成的动静脉（AV）移植物或瘘管时与血栓切除术相关的有症状的矛盾栓塞事件的发生率。
设计、地点、参与者和测量：这是一项在医院基础上进行的回顾性研究。它包括 23 名（10 名男性；平均年龄 65 岁）有 PFO 和血栓形成的血液透析移植物/瘘管的患者，他们接受了标准化的溶栓治疗，使用了 2 毫克阿替普酶和球囊血栓切除术。20 名患者（87%）有 AV 移植物，3 名（13%）有 AV 瘘管。PFO 分流在 2 名患者中为右向左（9%），在 8 名患者中为左向右（34%），在 10 名患者中为双向（44%）。在 3 名患者（13%）中未指定分流方向。计算了该患者人群中溶栓治疗的技术成功率和临床上表现出的矛盾栓塞事件的频率。
对 23 名有 PFO 的患者进行了 50 次溶栓治疗，技术成功率为 96%（48/50，96%）。在 23 名有 PFO 的患者中，均未发现有症状的矛盾栓塞事件。
经皮腔内血管血栓切除术治疗有记录的 PFO 患者血栓形成的 AV 移植物和瘘管后，出现有症状的矛盾栓塞事件罕见。该治疗方法在 PFO 患者中似乎是安全的。
