Lee Chang Hun, Gwon Jun Gyo, Jung Cheol Woong, Cho Sung Bum
Department of Transplantation and Vascular Surgery, Korea University College of Medicine, Seoul, South Korea.
Department of Radiology, Korea University College of Medicine, Seoul, South Korea.
J Vasc Access. 2020 Nov;21(6):1003-1010. doi: 10.1177/1129729820920105. Epub 2020 May 11.
Compared with the conventional approach, the benefits of the transjugular approach in endovascular intervention for hemodialysis access avoids complications due to direct puncture and reduces direct radiation exposure to the hands of operator. The aim of this non-inferiority study was to evaluate the efficacy of the transjugular approach in endovascular intervention for hemodialysis access comparing with conventional approach.
We retrospectively assessed endovascular intervention for hemodialysis access performed in our hospital from 2012 to 2016, divided into the conventional approach group and the transjugular approach group. The hemodialysis access survival rate, re-intervention survival rate, and lesion characteristics were comparatively evaluated.
We included 223 cases in 118 patients (146 cases with conventional approaches and 77 cases with transjugular approaches). There was a higher incidence of thrombosis with the conventional approach (p < 0.001), however, no significant difference in the hemodialysis access type or main lesion location. The transjugular approach showed either a better hemodialysis access survival rate (p = 0.017) and a trend toward improved re-intervention survival rate (p = 0.098) than the conventional approach. Following classification according to the presence of thrombus, there was no significant difference in either the hemodialysis access survival rate or the re-intervention survival rate between the approaches with or without thrombus.
The transjugular approach could be performed in most cases and was similar to the conventional approach in terms of outcomes. The transjugular approach should be considered as an alternative to either replace or use in combination with the conventional approach in endovascular intervention for hemodialysis access.
与传统方法相比，经颈静脉途径在血液透析通路血管内介入治疗中的优势在于可避免直接穿刺引起的并发症，并减少术者手部的直接辐射暴露。本非劣效性研究的目的是评估经颈静脉途径在血液透析通路血管内介入治疗中的疗效，并与传统方法进行比较。
我们回顾性评估了2012年至2016年在我院进行的血液透析通路血管内介入治疗，分为传统方法组和经颈静脉途径组。对血液透析通路生存率、再次介入生存率和病变特征进行了比较评估。
我们纳入了118例患者的223例病例（146例采用传统方法，77例采用经颈静脉途径）。传统方法的血栓形成发生率较高（p<0.001），然而，在血液透析通路类型或主要病变部位方面没有显著差异。与传统方法相比，经颈静脉途径显示出更好的血液透析通路生存率（p=0.017）和再次介入生存率改善的趋势（p=0.098）。根据血栓的存在进行分类后，有血栓和无血栓的方法在血液透析通路生存率或再次介入生存率方面均无显著差异。
经颈静脉途径在大多数情况下均可实施，且在疗效方面与传统方法相似。在血液透析通路血管内介入治疗中，经颈静脉途径应被视为替代传统方法或与传统方法联合使用的一种选择。
