Ali Haitham, Attallah Khaled, Awad Khaled, Thabet Bahgat
Department of Vascular and Endovascular Surgery, Assiut University Hospitals, Assiut, Egypt -
Department of Vascular and Endovascular Surgery, Assiut University Hospitals, Assiut, Egypt.
Int Angiol. 2019 Apr;38(2):143-149. doi: 10.23736/S0392-9590.19.04064-1. Epub 2019 Jan 16.
To report our experience and evaluate the results of a hybrid procedure comprising of surgical thrombectomy and adjuvant high pressure balloon angioplasty for management of thrombosed arteriovenous grafts (AVGs) with underlying venous anastomotic stenosis.
Between January 2015 and June 2017, 148 patients with first-time thrombosis of AVGs were considered for treatment with surgical thrombectomy followed by high pressure balloon angioplasty of the underlying venous anastomotic lesions. Monitoring and surveillance was subsequently performed using clinical and hemodialysis criteria to detect a failing/failed access. Primary, assisted primary, and secondary patency rates were calculated using Kaplan-Meier analysis.
This hybrid procedure was technically successful in 135 cases (91.2%) and clinically successful in 131 cases (88.5%). The postintervention primary patency rate of the target lesions was 68.2%, 52.4%, and 44.2% at 3, 6, and 12 months, respectively. Endovascular re-interventions increased significantly the postintervention assisted primary patency to 79.1%, 71.9%, and 66.8% (P=0.0004), and the postintervention secondary patency to 86.5%, 82.2%, and 78.6% (P<0.0001) at the same time points, respectively.
Hybrid salvage of thrombosed AVGs using high pressure balloon angioplasty of the venous anastomotic stenosis following surgical thrombectomy by Fogarty catheter is a highly successful and safe procedure, with acceptable short-term primary patency. The need for repeated interventions demonstrates the necessity of continuous graft monitoring and surveillance to improve both assisted primary, and secondary patency rates.
报告我们采用手术取栓术联合辅助高压球囊血管成形术治疗合并潜在静脉吻合口狭窄的血栓形成动静脉内瘘（AVG）的经验并评估结果。
2015年1月至2017年6月期间，148例首次出现AVG血栓形成的患者接受了手术取栓术治疗，随后对潜在的静脉吻合口病变进行高压球囊血管成形术。随后使用临床和血液透析标准进行监测和随访，以检测功能不良/失败的通路。采用Kaplan-Meier分析计算初次、辅助初次和二次通畅率。
该联合手术在135例（91.2%）患者中技术成功，131例（88.5%）患者临床成功。干预后目标病变的初次通畅率在3个月、6个月和12个月时分别为68.2%、52.4%和44.2%。血管腔内再次干预显著提高了干预后的辅助初次通畅率，在相同时间点分别提高到79.1%、71.9%和66.8%（P=0.0004），干预后的二次通畅率分别提高到86.5%、82.2%和78.6%（P<0.0001）。
采用Fogarty导管手术取栓术后对静脉吻合口狭窄进行高压球囊血管成形术对血栓形成的AVG进行联合挽救是一种非常成功且安全的手术，短期初次通畅率可接受。重复干预的必要性表明持续监测和随访移植物以提高辅助初次和二次通畅率的必要性。
