Nassar George M, Rhee Edward, Khan Abdul Jabbar, Nguyen Binh, Achkar Katafan, Beathard Gerald
Dialysis Access Management Centers, Nephrology Dialysis and Transplantation Associates, The Kidney Institute & Houston Methodist Hospital, Weill Cornell University, Houston, Texas.
Semin Dial. 2015 Mar-Apr;28(2):E15-22. doi: 10.1111/sdi.12336. Epub 2014 Dec 22.
The purpose of this study was to report the results obtained in a cohort of 520 cases of thrombosed arteriovenous fistulas (AVF) treated by percutaneous intervention over a period of 8 years. The methods used varied according to the individual characteristics of the case. A clinical success rate of 91.1% was obtained with no significant difference being noted among radial-cephalic, brachial-cephalic, and brachial-basilic AVFs. The mean primary patency for this group was 227.3 ± 14.6 days, and the mean assisted primary patency was 677.2 ± 44.6 days. The lower arm AVFs had both a primary patency and an assisted primary patency that were significantly better than the upper arm cases (p = 0.006 and 0.002, respectively). The primary patency for radial-cephalic AVFs was significantly better than that for brachial-cephalic AVFs (p = 0.021), but not for brachial-basilic cases (p = 0.122). Assisted primary patency for radial-cephalic cases was significantly superior to the values for either patients with a brachial cephalic (p = 0.046) or a brachial-basilic (p = 0.004). Complications occurred in seven cases (1.3%), all of which were venous ruptures. Blood flow was affected in four cases. Only one of these was salvaged with angioplasty balloon tamponade. In the remaining three cases, the AVF was lost.
本研究的目的是报告一组520例血栓形成的动静脉内瘘（AVF）患者在8年期间接受经皮介入治疗所取得的结果。所采用的方法根据病例的个体特征而有所不同。临床成功率为91.1%，桡动脉-头静脉、肱动脉-头静脉和肱动脉-尺静脉动静脉内瘘之间未观察到显著差异。该组的平均初次通畅时间为227.3±14.6天，平均辅助初次通畅时间为677.2±44.6天。前臂动静脉内瘘的初次通畅率和辅助初次通畅率均显著优于上臂病例（分别为p = 0.006和0.002）。桡动脉-头静脉动静脉内瘘的初次通畅率显著优于肱动脉-头静脉动静脉内瘘（p = 0.021），但与肱动脉-尺静脉病例相比无显著差异（p = 0.122）。桡动脉-头静脉病例的辅助初次通畅率显著高于肱动脉-头静脉（p = 0.046）或肱动脉-尺静脉（p = 0.004）患者。7例（1.3%）发生并发症，均为静脉破裂。4例血流受到影响。其中只有1例通过血管成形术球囊压迫得以挽救。其余3例动静脉内瘘失功。
