Division of Vascular and Endovascular Surgery, Boston University, School of Medicine, Boston Medical Center, Boston, Mass.
Division of Interventional Radiology, Boston University, School of Medicine, Boston Medical Center, Boston, Mass.
J Vasc Surg. 2020 Dec;72(6):2107-2112. doi: 10.1016/j.jvs.2020.03.032. Epub 2020 Apr 11.
Maintenance of functional arteriovenous grafts (AVGs) for dialysis is difficult secondary to low primary patency, need for reinterventions, and limited alternative dialysis access options. We assessed our experience with percutaneous thrombectomy for treatment of occluded AVGs.
We performed a retrospective analysis of all percutaneous thrombectomies for AVGs from 2015 to 2017. These were generally performed using mechanical thrombectomy and occasional chemical tissue plasminogen activator thrombolysis, over-the-wire balloon embolectomy for inflow, and adjunctive inflow and outflow interventions as necessary. Perioperative outcomes, long-term patency, reinterventions, and need for new permanent access placement were analyzed.
There were 218 percutaneous thrombectomies performed on 86 AVGs in 77 patients. Approximately half (53.2%) of the patients were male and 68.8% were black. Mean age was 61.1 ± 13.0 years. At the time of thrombectomy, 73.8% underwent venous outflow interventions and 4.5% underwent arterial inflow interventions. Within 30 days, 24.8% of declotted grafts underwent repeated percutaneous thrombectomy, 14.3% required tunneled dialysis catheter placement, 4% developed minor access site or graft infections, and one patient underwent surgical arterial thrombectomy for arm ischemia. There were no venous thromboembolic, cardiopulmonary, or cerebrovascular complications or clinically significant pulmonary embolism. At 1 year and 3 years after percutaneous thrombectomy, freedom from repeated thrombosis was 37% and 18%, respectively, and freedom from new dialysis access placement was 66% and 51%, respectively. Overall patient survival was 82% at 3 years.
Percutaneous thrombectomy of AVGs is safe and is associated with acceptable patency rates. This minimally invasive method extends AVG use for these high-risk patients with limited dialysis access options.
由于功能动静脉移植物（AVG）的初次通畅率较低、需要再次介入治疗以及可供选择的透析通路有限，因此维持其功能较为困难。我们评估了经皮血栓切除术治疗 AVG 闭塞的经验。
我们对 2015 年至 2017 年期间所有经皮 AVG 血栓切除术进行回顾性分析。一般采用机械血栓切除术，偶尔使用化学组织纤溶酶原激活剂溶栓，经导丝球囊取栓术治疗入流，必要时辅助入流和出流干预。分析围手术期结局、长期通畅率、再次干预和新的永久性通路放置的需求。
77 例患者的 86 个 AVG 共进行了 218 次经皮血栓切除术。大约一半（53.2%）患者为男性，68.8%为黑人。平均年龄为 61.1±13.0 岁。在血栓切除术时，73.8%的患者进行了静脉流出干预，4.5%的患者进行了动脉流入干预。在 30 天内，24.8%的血栓溶解 AVG 需要再次经皮血栓切除术，14.3%需要置入股静脉隧道式透析导管，4%发生轻微的入路部位或移植物感染，1 例患者因手臂缺血行手术动脉取栓术。无静脉血栓栓塞、心肺或脑血管并发症或临床显著的肺栓塞。经皮血栓切除术 1 年和 3 年后，再次血栓形成的无复发率分别为 37%和 18%，新的透析通路放置的无复发率分别为 66%和 51%。总体患者 3 年生存率为 82%。
经皮 AVG 血栓切除术安全，通畅率可接受。这种微创方法延长了 AVG 的使用，为这些可供选择的透析通路有限的高危患者提供了帮助。
