Division of Vascular Surgery, University of Pittsburgh Medical Centre, Pittsburgh, PA, USA.
Division of Vascular Surgery, University of Pittsburgh Medical Centre, Pittsburgh, PA, USA.
Eur J Vasc Endovasc Surg. 2020 Dec;60(6):897-903. doi: 10.1016/j.ejvs.2020.08.012. Epub 2020 Sep 11.
Arteriovenous graft (AVG) failures are typically associated with venous anastomotic (VA) stenosis. Current evidence regarding AVG thrombosis management compares surgical with purely endovascular techniques; few studies have investigated the "hybrid" intervention that combines surgical balloon thrombectomy and endovascular angioplasty and/or stenting to address VA obstruction. This study aimed to describe outcomes after hybrid intervention compared with open revision (patch venoplasty or jump bypass) of the VA in thrombosed AVGs.
Retrospective cohort study. Consecutive patients with a thrombosed AVG who underwent thrombectomy between January 2014 and July 2018 were divided into open and hybrid groups based on VA intervention; patients who underwent purely endovascular thrombectomy were excluded. Patient demographics, previous access history, central vein patency, AVG anatomy, type of intervention, and follow up data were recorded. Kaplan-Meier curves were used to analyse time from thrombectomy to first re-intervention (primary patency) and time to abandonment (secondary patency). Cox regression analysis was performed to evaluate predictors of failure.
This study included 97 patients (54 females) with 39 forearm, 47 upper arm, and 11 lower extremity AVGs. There were 34 open revisions (25 patches, nine jump bypasses) and 63 hybrid interventions, which included balloon angioplasty ± adjunctive procedures (15 stents, five cutting balloons). Technique selection was based on physician preference. Primary patency for the open and hybrid groups was 27.8% and 34.2%, respectively, at six months and 17.5% and 12.9%, respectively, at 12 months (p = .71). Secondary patency was 45.1% and 38.5% for open and hybrid treatment, respectively, at 12 months (p = .87). An existing VA stent was predictive of graft abandonment (hazard ratio 4.4, 95% confidence interval 1.2-16.0; p = .024). Open vs. hybrid intervention was not predictive of failure or abandonment.
Hybrid interventions for thrombosed AVGs are not associated with worse patency at six and 12 months compared with open revision.
动静脉移植物（AVG）的失败通常与静脉吻合口（VA）狭窄有关。目前，关于 AVG 血栓形成管理的证据比较了手术与单纯血管内技术；很少有研究调查了将手术球囊血栓切除术与血管内血管成形术和/或支架置入术相结合以解决 VA 阻塞的“混合”干预。本研究旨在描述与血栓形成的 AVG 的 VA 开放修复（补片静脉成形术或跳跃旁路）相比，混合干预后的结果。
回顾性队列研究。2014 年 1 月至 2018 年 7 月期间接受血栓切除术的血栓形成的 AVG 患者根据 VA 干预分为开放组和混合组；排除仅行单纯血管内血栓切除术的患者。记录患者人口统计学、既往通路史、中心静脉通畅性、AVG 解剖结构、干预类型和随访数据。Kaplan-Meier 曲线用于分析从血栓切除术到首次再干预（原发性通畅）和放弃时间（继发性通畅）的时间。Cox 回归分析用于评估失败的预测因素。
本研究纳入了 97 名女性（54 名女性）患者，其中 39 名前臂、47 名上臂和 11 名下肢 AVG。有 34 例开放修复（25 例补片，9 例跳跃旁路）和 63 例混合干预，其中包括球囊血管成形术±辅助治疗（15 例支架，5 例切割球囊）。技术选择基于医生的偏好。开放组和混合组的原发性通畅率分别为 6 个月时 27.8%和 34.2%，12 个月时分别为 17.5%和 12.9%（p=0.71）。12 个月时开放和混合治疗的继发性通畅率分别为 45.1%和 38.5%（p=0.87）。存在 VA 支架是移植物放弃的预测因素（危险比 4.4，95%置信区间 1.2-16.0；p=0.024）。开放与混合干预与失败或放弃无关。
与开放修复相比，血栓形成的 AVG 的混合干预在 6 个月和 12 个月时的通畅率没有恶化。
