Hyun Jong Hee, Lee Jong Hoon, Park Sung Il
Department of Surgery, Kwandong University College of Medicine Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea.
J Korean Surg Soc. 2011 Jul;81(1):43-9. doi: 10.4174/jkss.2011.81.1.43. Epub 2011 Jul 11.
For the successful treatment of thrombosed autogenous arteriovenous fistula (AVF), we designed and performed a hybrid surgery. Its clinical outcomes were compared with those of percutaneous mechanical thrombectomy, retrospectively.
Forty cases of thrombosed autogenous AVFs underwent hybrid surgery, whereas 19 cases received percutaneous mechanical thrombectomy. Hybrid surgery consisted of surgical thrombectomy, balloon angioplasty and/or additional surgical angioplasty. Percutaneous mechanical thrombectomy included catheter-introduced thrombus aspiration, balloon angioplasty and/or stenting. Procedure related outcomes such as technical success rates and primary patency rates were analyzed, retrospectively.
There were no statistically significant differences between the two groups in terms of demographic data of the patients including age, gender, diabetes status, and frequency of antiplatelet use, as well as the characteristics of thrombosed autogenous AVFs such as access age, site, type, and length of time between thrombosis and AVF creation (P > 0.05). Technical success rates (92.5% vs. 68.4%, P = 0.005, respectively) and primary patency rates (85.9% vs. 36.8% at 6 months, 81.1% vs. 26.3% at 12 months, 81.1% vs.21.1% at 18 and 24 months respectively, log-rank test, (P < 0.001) were significantly higher in the hybrid surgery group. In terms of cost analysis, supply cost was not different (P = 0.065), but total cost was statistically lower in the hybrid surgery group (P = 0.019).
Hybrid surgery showed better technical success rates and patency rates in the salvaging of thrombosed autogenous AVFs than in percutaneous mechanical thrombectomy.
为成功治疗血栓形成的自体动静脉内瘘（AVF），我们设计并实施了一种杂交手术。回顾性地将其临床结果与经皮机械性血栓切除术的结果进行比较。
40例血栓形成的自体AVF患者接受了杂交手术，而19例患者接受了经皮机械性血栓切除术。杂交手术包括手术取栓、球囊血管成形术和/或额外的手术血管成形术。经皮机械性血栓切除术包括导管介导的血栓抽吸、球囊血管成形术和/或支架置入术。回顾性分析手术相关结果，如技术成功率和初次通畅率。
两组患者的人口统计学数据，包括年龄、性别、糖尿病状态、抗血小板药物使用频率，以及血栓形成的自体AVF的特征，如通路使用时间、部位、类型以及血栓形成与AVF建立之间的时间长度，差异均无统计学意义（P>0.05）。杂交手术组的技术成功率（分别为92.5%和68.4%，P=0.005）和初次通畅率（6个月时分别为85.9%和36.8%，12个月时分别为81.1%和26.3%，18个月和24个月时分别为81.1%和21.1%，对数秩检验，P<0.001）显著更高。在成本分析方面，耗材成本无差异（P=0.065），但杂交手术组的总成本在统计学上更低（P=0.019）。
在挽救血栓形成的自体AVF方面，杂交手术比经皮机械性血栓切除术显示出更好的技术成功率和通畅率。
