Singh Rajaram Yogeshwar, Le Thong, Ross-Smith Maree, Owen Andrew, Chuen Jason, Mount Peter F
Clin Nephrol. 2017 Sep;88(9):140-147. doi: 10.5414/CN109080.
Acute thrombosis of hemodialysis (HD) arteriovenous access is an urgent problem for HD patients and is commonly managed by endovascular thrombolysis. Pulmonary embolism (PE) is a recognized complication of HD access thrombosis and thrombolysis but the risk and outcomes are unclear. This study aims to determine the incidence, predictors, and outcomes of PE after endovascular thrombolysis of HD arteriovenous access in patients presenting with acute thrombosis.
A single-center retrospective study was performed for all adult chronic kidney disease patients undergoing arteriovenous access thrombolysis between January 1, 2012, and December 31, 2014. Investigation for PE with CT pulmonary angiography or ventilation/perfusion scintigraphy (V/Q scan) was performed as clinically directed by the managing clinicians. In cases diagnosed with PE, the pulmonary embolism severity index (PESI) was calculated.
A total of 48 (median age 68) patients underwent 74 thrombolysis procedures. Thrombolysis techniques were divided into pharmacological (44.6%), mechanical (17.6%), or pharmacomechanical (37.8%). Clinical success was achieved in 56/74 (75.7%) of procedures. Five episodes of thrombolysis for access thrombosis (6.8%) were associated with clinically symptomatic PE. The PESI score ranged from 51 to 127. All patients with PE were managed with 3 - 6 months of anticoagulation and recovered clinically. There were no statistically significant differences in baseline characteristics, methods of thrombolysis, or clot burden in patients that developed a PE.
CONCLUSION: There is a clinically significant risk of symptomatic PE after arteriovenous access thrombolysis for access thrombosis in HD patients. .
血液透析（HD）动静脉通路急性血栓形成是HD患者面临的一个紧迫问题，通常采用血管内溶栓治疗。肺栓塞（PE）是HD通路血栓形成和溶栓治疗公认的并发症，但风险和预后尚不清楚。本研究旨在确定急性血栓形成患者HD动静脉通路血管内溶栓后PE的发生率、预测因素和预后。
对2012年1月1日至2014年12月31日期间接受动静脉通路溶栓治疗的所有成年慢性肾脏病患者进行单中心回顾性研究。根据临床医生的指导，采用CT肺血管造影或通气/灌注闪烁扫描（V/Q扫描）对PE进行检查。对于诊断为PE的病例，计算肺栓塞严重程度指数（PESI）。
共有48例（中位年龄68岁）患者接受了74次溶栓治疗。溶栓技术分为药物溶栓（44.6%）、机械溶栓（17.6%）或药物机械联合溶栓（37.8%）。56/74例（75.7%）治疗取得临床成功。5例（6.8%）通路血栓形成的溶栓治疗与临床症状性PE相关。PESI评分范围为51至127。所有PE患者均接受了3至6个月的抗凝治疗，临床症状缓解。发生PE的患者在基线特征、溶栓方法或血栓负荷方面无统计学显著差异。
HD患者动静脉通路血栓形成进行溶栓治疗后，有发生症状性PE的显著临床风险。
