Vascular & Interventional Unit, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Thailand.
Ann Acad Med Singap. 2015 Feb;44(2):66-70.
The key to treatment of a thrombosed dialysis graft is restoration and maintenance of function as long as possible. The objective of this study was to compare the outcomes of pharmacomechanical thrombolysis and surgical thrombectomy in the treatment of thrombosed haemodialysis grafts.
During a 3-year period, 108 patients with 114 thrombosed dialysis grafts were referred to our institute for treatment. Fifty thrombosed dialysis grafts underwent pulse-spray catheter thrombolysis using recombinant tissue plasminogen activator (rt-PA) with angioplasty, and 64 thrombosed dialysis grafts underwent surgical thrombectomy. The procedural success rates, complications and average patency times and patency rates were compared between the 2 procedures. P values less than 0.05 were considered to be statistically significant.
There were no statistically significant differences between the pharmacomechanical thrombolysis group and the thrombectomy group in the procedural success rates (94% and 93.8%, P = 0.15) or average patency times (6.24 months and 6.30 months, P = 0.17). The primary and secondary patency rates at 12 months were 28.0% ± 8.4% and 54.3% ± 7.8% for the thrombolysis with angioplasty group, and 30.0% ± 6.3% and 57.0% ± 4.8% for the thrombectomy group, respectively (P = 0.65 and P = 0.49, respectively). There were no procedural-related major complications.
Our study found no differences in outcomes between patients treated with pharmacomechanical thrombolysis and surgical thrombectomy for thrombosed haemodialysis grafts. Pharmacomechanical thrombolysis can be considered as an alternative treatment for dialysis graft thrombosis.
治疗血栓形成的透析移植物的关键是尽可能长时间地恢复和维持其功能。本研究的目的是比较溶栓和血栓切除术治疗血栓形成的血液透析移植物的效果。
在 3 年期间，有 108 例 114 例血栓形成的透析移植物患者被转诊到我们的研究所进行治疗。50 例血栓形成的透析移植物采用重组组织纤溶酶原激活物（rt-PA）经皮腔内血管成形术脉冲喷射导管溶栓，64 例血栓形成的透析移植物采用手术血栓切除术。比较了两种方法的程序成功率、并发症以及平均通畅时间和通畅率。P 值小于 0.05 被认为具有统计学意义。
溶栓组和血栓切除术组在程序成功率（94%和 93.8%，P = 0.15）或平均通畅时间（6.24 个月和 6.30 个月，P = 0.17）方面无统计学差异。溶栓加血管成形术组的 12 个月时的主要和次要通畅率分别为 28.0%±8.4%和 54.3%±7.8%，血栓切除术组分别为 30.0%±6.3%和 57.0%±4.8%（P = 0.65 和 P = 0.49）。无程序相关的主要并发症。
我们的研究发现，溶栓和血栓切除术治疗血栓形成的血液透析移植物的结果没有差异。溶栓可以作为透析移植物血栓形成的替代治疗方法。
