Leo Christopher Cheang Han, Cassorla Gabriel, Swinnen Jan
University Medicine Cluster, Division of Nephrology, National University Hospital, Singapore.
Department of Vascular Surgery, The German Clinic of Santiago and Sotero del Rio Hospital, Santiago, Chile.
ANZ J Surg. 2020 Jul;90(7-8):1369-1375. doi: 10.1111/ans.16121. Epub 2020 Jul 20.
Arteriovenous fistula is the definitive vascular access for patients on long-term haemodialysis. The aim of this study is to present the techniques and results of the Endovascular Treatment System that we have developed for managing the occluded native arteriovenous fistula.
The current study is a retrospective chart review on all patients who presented with an occluded native arteriovenous fistula and underwent attempted recanalization between 1 January 2005 and 31 December 2014.
A total of 130 patients were included in the study. Post-intervention primary access patency was 83.8% at 6 months, 78.7% at 12 months, 64.6% at 2 years and 59.6% at 3 years. Post-intervention assisted access patency in fistulas-in-use was 86.5% at 6 months, 81% at 12 months, 66.8% at 2 years and 61.2% at 3 years. Post-intervention secondary patency for all cases was 84.7% at 6 months, 80.2% at 12 months, 66.1% at 2 years and 62% at 3 years. Post-intervention secondary patency in fistula-in-use was 91.1% at 6 months, 90% at 12 months, 85% at 2 years and 74.6% at 3 years. Access survival nor patency differed significantly when incisional thrombectomy was compared to angioplasty with or without stenting with access survival of 91.2% and 92.5% at 12 months and access patency of 82.9% and 89.7% at 12 months (P = 0.834 and P = 0.898, respectively).
In autologous arteriovenous thrombosed fistulae, the use of endovascular techniques to revive the access is a viable and safe technique to employ in most cases.
动静脉内瘘是长期血液透析患者的确定性血管通路。本研究的目的是介绍我们开发的用于处理闭塞的自体动静脉内瘘的血管内治疗系统的技术和结果。
本研究是一项回顾性图表审查，针对2005年1月1日至2014年12月31日期间出现闭塞的自体动静脉内瘘并尝试进行再通的所有患者。
本研究共纳入130例患者。干预后6个月时初次通路通畅率为83.8%，12个月时为78.7%，2年时为64.6%，3年时为59.6%。干预后正在使用的内瘘辅助通路通畅率6个月时为86.5%，12个月时为81%，2年时为66.8%，3年时为61.2%。所有病例干预后的二次通畅率6个月时为84.7%，12个月时为80.2%，2年时为66.1%，3年时为62%。正在使用的内瘘干预后的二次通畅率6个月时为91.1%，12个月时为90%，2年时为85%，3年时为74.6%。将切开取栓术与有或无支架置入的血管成形术相比较，通路生存率和通畅率无显著差异，12个月时通路生存率分别为91.2%和92.5%，12个月时通路通畅率分别为82.9%和89.7%（P分别为0.834和0.898）。
在自体动静脉血栓形成的内瘘中，使用血管内技术恢复通路在大多数情况下是一种可行且安全的技术。
