Troisi Nicola, Chisci Emiliano, Frosini Pierfrancesco, Romano Eugenio, Setti Marco, Mingardi Giulio, Michelagnoli Stefano
2 Department of Cardiovascular Disease, Section of Vascular Surgery, Cliniche Humanitas Gavazzeni, Bergamo - Italy.
J Vasc Access. 2014 Sep-Oct;15(5):396-400. doi: 10.5301/jva.5000218. Epub 2014 Apr 5.
The aim of the study was to evaluate our experience in the hybrid simultaneous treatment (open and endovascular) of acute thrombosis of prosthetic grafts for hemodialysis.
Between January 2011 and June 2013, 23 patients with acute thrombosis of a prosthetic graft for hemodialysis were urgently treated with a hybrid simultaneous treatment in order to obtain a prompt restoration of the flow. A new puncture of the graft was scheduled after 24 hours.
Intraoperative technical success was 100% with a completion angiography showing the restored patency of the graft. As adjunctive procedures, in 6 patients (26.1%) locoregional thrombolysis was necessary and in all cases further endovascular manoeuvres (angioplasty/stenting) were immediately performed to solve a significant stenosis of the venous anastomosis/first tract of the vein. At 24 hours when the first puncture was done, three grafts were occluded resulting in a primary patency of 87%. During the follow-up (mean duration 5.6 months) four reocclusions occurred. In-stent restenosis occurred in all patients undergone stenting. At 1 year the rates of primary patency, primary assisted patency and secondary patency were 58.7%, 78.3% and 87%, respectively.
In our series the combined simultaneous hybrid approach in urgency maximizes the use of different available techniques, which appeared to improve overall success rate to save a thrombosed graft for hemodialysis. The great difference showed between primary and primary assisted patency demonstrates the necessity of a close follow-up.
本研究旨在评估我们在采用开放与血管腔内联合同步治疗方法处理血液透析人工血管急性血栓形成方面的经验。
在2011年1月至2013年6月期间，23例血液透析人工血管急性血栓形成患者接受了紧急联合同步治疗，以迅速恢复血流。计划在24小时后对人工血管进行新的穿刺。
手术技术成功率为100%，完成血管造影显示人工血管通畅恢复。作为辅助操作，6例患者（26.1%）需要进行局部溶栓，并且在所有病例中均立即进行了进一步的血管腔内操作（血管成形术/支架置入术）以解决静脉吻合口/静脉起始段的严重狭窄。在24小时进行首次穿刺时，有3条人工血管闭塞，导致初始通畅率为87%。在随访期间（平均持续时间5.6个月）发生了4次再闭塞。所有接受支架置入术的患者均发生了支架内再狭窄。1年时，初始通畅率、初始辅助通畅率和二次通畅率分别为58.7%、78.3%和87%。
在我们的系列研究中，紧急联合同步混合方法最大限度地利用了不同的可用技术，这似乎提高了总体成功率，从而挽救了用于血液透析的血栓形成人工血管。初始通畅率和初始辅助通畅率之间的巨大差异表明密切随访的必要性。
