Koraen-Smith Linn, Krasun Matteus, Bottai Matteo, Hedin Ulf, Wahlgren Carl M, Gillgren Peter
1 Department of Vascular Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
2 Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
J Vasc Access. 2018 Nov;19(6):535-541. doi: 10.1177/1129729818761277. Epub 2018 Apr 3.
: Thrombosis is one of the most common complications of dialysis vascular access and is a significant source of morbidity and healthcare-associated costs. In this retrospective study, outcomes for surgical thrombectomy and thrombolysis after access thrombosis in patients with arteriovenous fistulas or prosthetic grafts (arteriovenous grafts) were analysed.
: All patients with a primary episode of dialysis access thrombosis between 2005 and 2013 were included which yielded 131 patients with 149 episodes of access thrombosis (108 arteriovenous grafts; 41 arteriovenous fistulas). In all, 18 patients had two separate accesses during the study. Patient demographics, access anatomy, surgical and radiological procedural data were recorded. Kaplan-Meier estimates and Poisson regression were used for statistical analysis of access patency.
: In total, 107 underwent surgical thrombectomy and 42 were treated with catheter-directed thrombolytic infusion. Technical success was 60% for surgical thrombectomy and 73% for thrombolysis (p = 0.18). There were no major complications and no deaths within 30 days of the procedure. More patients had adjunctive procedures in the thrombolysis group (65/107 vs 37/42; p = 0.002). There was an increasing risk of rethrombosis or a further access-related event for both arteriovenous fistulas and arteriovenous grafts after open thrombectomy compared with catheter-directed thrombolytic infusion, and arteriovenous fistulas exhibited a lower risk than arteriovenous grafts with an average increase in risk of 23.9% (95% confidence interval: 3.1-49) between each treatment group.
: Thrombolysis for thrombosis of native and prosthetic dialysis accesses appears to yield better assisted primary patency compared to surgical thrombectomy. Our results suggest that thrombolysis may be considered the first-choice method for treating the thrombosed dialysis access.
血栓形成是透析血管通路最常见的并发症之一，是发病和医疗相关费用的重要来源。在这项回顾性研究中，分析了动静脉内瘘或人工血管（动静脉移植物）患者血管通路血栓形成后手术取栓和溶栓的结果。
纳入2005年至2013年间首次发生透析血管通路血栓形成的所有患者，共131例患者发生149次血管通路血栓形成事件（108例动静脉移植物；41例动静脉内瘘）。共有18例患者在研究期间有两个独立的血管通路。记录患者人口统计学、血管通路解剖结构、手术和放射学程序数据。采用Kaplan-Meier估计法和泊松回归分析血管通路通畅情况。
总共107例接受了手术取栓，42例接受了导管定向溶栓输注治疗。手术取栓的技术成功率为60%，溶栓的技术成功率为73%（p = 0.18）。术后30天内无重大并发症和死亡病例。溶栓组有更多患者接受了辅助治疗（65/107 vs 37/42；p = 0.002）。与导管定向溶栓输注相比，开放式取栓术后动静脉内瘘和动静脉移植物再次血栓形成或发生其他与血管通路相关事件的风险均增加，且动静脉内瘘的风险低于动静脉移植物，每个治疗组之间的风险平均增加23.9%（95%置信区间：3.1-49）。
对于天然和人工透析血管通路血栓形成，溶栓似乎比手术取栓能产生更好的辅助原发性通畅率。我们的结果表明，溶栓可被视为治疗血栓形成的透析血管通路的首选方法。
