Department of Cardiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
Department of Nephrology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
J Vasc Access. 2023 Sep;24(5):957-964. doi: 10.1177/11297298211058984. Epub 2021 Nov 29.
Traditionally, percutaneous transluminal angioplasty (PTA) is a first-line approach for stenosed dialysis accesses and has been performed through the non-thrombosed vein segment. For thrombosed accesses, thrombectomy (whether open or percutaneous) is a standard approach. The primary objective of our study is to determine the clinical and technical outcomes of the trans-radial approach of PTA among thrombosed dialysis accesses, in terms of safety and feasibility, technical and clinical aspects and factors influencing them, as well as assisted primary patency, secondary patency at 6 and 12 months.
This is a single-center retrospective study that included 150 patients over 3 years. About 123 patients underwent successful percutaneous balloon angioplasty through the radial access.
We report an overall technical and clinical success rate of 82%, assisted primary patency rate of about 90.25% at 3 months, 82.93% at 6 months, 73.18% at 1 year, and secondary patency rate of 94% at 1 year. Twenty-seven patients were referred for surgical revisions/creation of a new fistula for reasons like inability to pass wire (6 patients), unfavorable anatomical variations like aneurysms at the proximal segments (5 patients), inability to cross the fistula (5 patients), and persistent fistula dysfunction with no flow after initial balloon dilatation (11 patients). Three patients had hematoma at the radial access site (2.5%) while two patients had the AV fistula segment rupture and were successfully treated conservatively.
We conclude that PTA through the trans-radial approach to completely thrombosed hemodialysis accesses is a good alternative to transvenous access and has a very good assisted primary patency and secondary patency at 1 year without major complications.
传统上，经皮腔内血管成形术（PTA）是狭窄透析通路的一线治疗方法，并且已经在未血栓形成的静脉段进行。对于血栓形成的通路，血栓切除术（无论是开放性还是经皮性）是一种标准方法。我们研究的主要目的是确定经皮桡动脉入路治疗血栓形成的透析通路的临床和技术结果，从安全性和可行性、技术和临床方面以及影响它们的因素，以及辅助一期通畅率、6 个月和 12 个月时的二期通畅率。
这是一项为期 3 年的单中心回顾性研究，共纳入 150 例患者。约 123 例患者通过桡动脉入路成功进行了经皮球囊血管成形术。
我们报告了总体技术和临床成功率为 82%，辅助一期通畅率约为 3 个月时的 90.25%、6 个月时的 82.93%、1 年时的 73.18%和 1 年时的二期通畅率为 94%。27 例患者因无法通过导丝（6 例）、近端节段出现动脉瘤等不利解剖变异（5 例）、无法穿过瘘管（5 例）、以及初始球囊扩张后瘘管功能持续障碍且无血流（11 例）等原因转至手术修复/创建新瘘管。3 例患者桡动脉入路部位出现血肿（2.5%），2 例患者瘘管段破裂，经保守治疗成功。
我们得出结论，经皮桡动脉入路治疗完全血栓形成的血液透析通路是经静脉入路的良好替代方法，具有很好的辅助一期通畅率和 1 年时的二期通畅率，且无重大并发症。
