Regus Susanne, Lang Werner, Heinz Marco, Rother Ulrich, Meyer Alexander, Almási-Sperling Veronika, Uder Michael, Schmid Axel
Department of Vascular Surgery, University Hospital, Erlangen, Germany.
Institute of Radiology, University Hospital, Erlangen, Germany.
Hemodial Int. 2018 Jan;22(1):31-36. doi: 10.1111/hdi.12528. Epub 2017 Jan 3.
This study describes results of a modified local thrombolysis technique for acutely thrombosed hemodialysis (HD) arteriovenous fistulas (AVF), which is characterized by prolonged recombinant tissue plasminogen activator (rtPA) local exposure times. Contrary to the standard lyse- and- wait (L&W) technique with local reaction times of 20-40 minutes, the modified protocol allows timing of challenging angioplasty maneuvers to the next regular working day.
From February 2009 to April 2014, 84 patients on HD presented with 152 acutely thrombosed AVF. They proceeded to local thrombolysis including a single shot infiltration of rtPA, local reaction time up to 40 hours and finally percutaneous stenosis angioplasty. Success rates, major adverse events and need for temporary catheter placements (TCP) were retrospectively analyzed.
The local thrombolysis time after single shot infiltration was 18.6 ± 6.2 (range 2-40) hours. Mean rtPA- dosage was 2.7 mg ± 1.2. The overall success rate was 89.5% and the major complication rate was 3.3%, whereas TCP was necessary in 12.5%. The PP/SP at 1, 3, 6, 12, 18, and 24 month were 86% ± 3%/95% ± 2%, 68% ± 4%/92% ± 2%, 43% ± 4%/90% ± 2%, 28% ± 4%/82% ± 3%, 12% ± 3%/82% ± 3%, 7% ± 2%/63% ± 4%, respectively.
The modified L&W technique with prolonged local rtPA reaction times is a safe and effective declotting procedure. The need for TCP was not increased and therefore comparable to the standard technique.
本研究描述了一种改良的局部溶栓技术治疗急性血栓形成的血液透析（HD）动静脉内瘘（AVF）的结果，其特点是重组组织型纤溶酶原激活剂（rtPA）局部暴露时间延长。与局部反应时间为20 - 40分钟的标准溶解并等待（L&W）技术相反，改良方案允许将具有挑战性的血管成形术操作安排到下一个正常工作日。
2009年2月至2014年4月，84例接受血液透析的患者出现152例急性血栓形成的动静脉内瘘。他们接受了局部溶栓治疗，包括单次注射rtPA、局部反应时间长达40小时，最后进行经皮狭窄血管成形术。对成功率、主要不良事件和临时导管置入（TCP）需求进行回顾性分析。
单次注射后的局部溶栓时间为18.6±6.2（范围2 - 40）小时。rtPA平均剂量为2.7 mg±1.2。总体成功率为89.5%，主要并发症发生率为3.3%，而12.5%的患者需要进行临时导管置入。1、3、6、12、18和24个月时的初级通畅率/次级通畅率分别为86%±3%/95%±2%、68%±4%/92%±2%、43%±4%/90%±2%、28%±4%/82%±3%、12%±3%/82%±3%、7%±2%/63%±4%。
延长局部rtPA反应时间的改良L&W技术是一种安全有效的溶栓程序。临时导管置入的需求并未增加，因此与标准技术相当。
