Division of Vascular Surgery, Vascular Institute of New York, Brooklyn, NY.
Division of Vascular Surgery, Vascular Institute of New York, Brooklyn, NY.
J Vasc Surg. 2018 Mar;67(3):857-859. doi: 10.1016/j.jvs.2017.07.135. Epub 2017 Oct 7.
The purpose of the study was to aggressively salvage acutely occluded arteriovenous fistulas (AVFs) using duplex imaging as the sole imaging modality for percutaneous transluminal angioplasty of acutely thrombosed AVF.
Over a period of 12 months, 14 patients with acute thrombosis of their AVFs underwent 18 procedures in a single center for AVF salvage. All 14 patients presented with chronic renal failure, and six were diabetic. All patients were treated under duplex guidance alone. Treatment included simple balloon dilation and maceration (group A; n =10 procedures [56%]) for subacute thrombosis or pharmacomechanical thrombectomy (group B; n = 8 procedures [44%]) for more hypoechoic thrombus. A successful procedure was defined as immediate restoration of flow through the AVF.
Of the 18 procedures, 13 (72%) were successful. Of the 14 patients, thrombus was located at the perianastomotic AVF in 6 (43%), proximal-mid AVF in 6 (43%), mid AVF in 1 (7%), and distal AVF in 1 (7%). From group A, six (60%) were successful. From group B, seven (88%) were successful. Among the unsuccessful procedures, one group B patient was hypercoagulable (polycythemia vera). Of the 18 procedures, 16 (89%) were treated within 2 weeks from when duplex revealed the presence of thrombus. Early rethrombosis (<1-month patency) occurred in three cases (17%), and these patients received new fistulas. Full restoration of the fistula flow was established in 14 cases (78%). Of these 14 patients, 8 (57%) are currently on hemodialysis via fistula, 3 patients (21%) had newly placed fistulas after failed interventions, 2 patients (14%) are not on dialysis yet, and 1 patient (7%) with polycythemia vera disorder is on dialysis via a Tesio catheter (MedComp, Harleysville, Pa).
The sole use of duplex ultrasound imaging to salvage acutely occluded AVFs using percutaneous transluminal angioplasty is a safe and effective alternative to traditional treatment of thrombosed failing/maturing AVF.
本研究的目的是使用双功能超声成像作为经皮腔内血管成形术治疗急性血栓形成动静脉瘘（AVF）的唯一影像学方法，积极抢救急性闭塞的 AVF。
在 12 个月的时间里，在一家中心，14 例 AVF 急性血栓形成的患者接受了 18 次 AVF 挽救治疗。所有 14 例患者均为慢性肾衰竭，6 例为糖尿病患者。所有患者均单独在双功能超声引导下接受治疗。治疗包括急性血栓形成时采用单纯球囊扩张和侵蚀（A 组；10 次治疗[56%]），或采用药物机械血栓切除术（B 组；8 次治疗[44%]）治疗回声较低的血栓。手术成功的定义是 AVF 立即恢复血流。
18 次治疗中，13 次（72%）成功。14 例患者中，吻合口周围 AVF 血栓 6 例（43%），近-中 AVF 血栓 6 例（43%），中 AVF 血栓 1 例（7%），远 AVF 血栓 1 例（7%）。A 组 6 例（60%）成功，B 组 7 例（88%）成功。在不成功的治疗中，1 例 B 组患者存在高凝状态（真性红细胞增多症）。18 次治疗中，16 次（89%）在双功能超声发现血栓后 2 周内进行。3 例（17%）早期再血栓形成（1 个月内通畅率），这些患者接受了新的瘘管。14 例患者（78%）的瘘管血流完全恢复。在这 14 例患者中，8 例（57%）通过瘘管进行血液透析，3 例（21%）在介入失败后新放置瘘管，2 例（14%）尚未进行透析，1 例（7%）因真性红细胞增多症障碍通过 Tesio 导管（MedComp，Harleysville，Pa）进行透析。
单独使用双功能超声成像经皮腔内血管成形术抢救急性闭塞的 AVF 是一种安全有效的替代传统治疗血栓形成的失功/成熟 AVF 的方法。
