Lim Darryl, Ho Derek C, Chen Lionel, Schreve Michiel A, Tan Yih Kai, Kum Steven
Vascular Service, Department of Surgery, Changi General Hospital, Singapore - Singapore.
Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar - The Netherlands.
J Vasc Access. 2017 Nov 17;18(6):508-514. doi: 10.5301/jva.5000768. Epub 2017 Jul 27.
The aim of this prospectively collected case series is to demonstrate a novel technique of using the ClariVein® catheter for pharmacomechanical thrombolysis of thrombosed hemodialysis grafts.
The analysis comprised 11 procedures in 9 patients from 1 July to 31 December 2016 in which the ClariVein catheter was used in combination with urokinase. Demographic data, procedural data, technical and clinical success rates, and complications were evaluated. The primary and secondary patency rates at 1 and 3 months were also analyzed.
In the 11 procedures performed, the technical and clinical success was 100%. The mean procedural time was 66.8 minutes (range 50-90 minutes), and the mean amount of urokinase administered was 87,000 units. The primary unassisted patency rates at 1 and 3 months were 81.8% and 63.6%, respectively. The secondary patency rates at 1 and 3 months were 90.9% and 81.8%, respectively. Perforation occurred after balloon angioplasty in 1 (9.1%) of the 11 procedures, for which covered stenting was performed. No major complications occurred.
The combination use of the ClariVein catheter with urokinase for pharmacomechanical thrombolysis in thrombosed hemodialysis grafts is a feasible and safe method that can be performed in a relatively short duration. Our early results have shown 100% technical and clinical success. This case series serves as a platform for an upcoming prospective study to further evaluate this method.
本前瞻性收集的病例系列旨在展示一种使用ClariVein®导管对血栓形成的血液透析移植物进行药物机械溶栓的新技术。
分析包括2016年7月1日至12月31日期间9例患者的11次手术，其中ClariVein导管与尿激酶联合使用。评估了人口统计学数据、手术数据、技术和临床成功率以及并发症。还分析了1个月和3个月时的初级和次级通畅率。
在进行的11次手术中，技术和临床成功率均为100%。平均手术时间为66.8分钟（范围50 - 90分钟），平均尿激酶用量为87,000单位。1个月和3个月时的初级无辅助通畅率分别为81.8%和63.6%。1个月和3个月时的次级通畅率分别为90.9%和81.8%。11次手术中有1次（9.1%）在球囊血管成形术后发生穿孔，对此进行了覆膜支架置入术。未发生重大并发症。
ClariVein导管与尿激酶联合用于血栓形成的血液透析移植物的药物机械溶栓是一种可行且安全的方法，可在相对较短的时间内完成。我们的早期结果显示技术和临床成功率均为100%。本病例系列为即将开展的前瞻性研究提供了一个平台，以进一步评估该方法。
