Division of Renal medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
Nephrol Dial Transplant. 2022 Aug 22;37(9):1742-1750. doi: 10.1093/ndt/gfac036.
There is no consensus whether an arteriovenous (AV) access thrombosis is best treated by surgical or endovascular intervention. We compared the influence of surgical versus endovascular intervention for AV access thrombosis on access survival using real-life data from a national access registry.
We included patients from the Swedish Renal Access Registry (SRR-Access) with a working AV access undergoing surgical or endovascular intervention for their first thrombosis between 2008 and 2020. The primary outcome was the risk of access abandonment (secondary patency at 30, 60, 90 and 365 days). Secondary outcomes were time to next intervention and 30-day mortality. Access characteristics were obtained from the SRR-Access and patient characteristics were collected from the Swedish Renal Registry. Outcomes were assessed with multivariable logistic regression and Cox proportional hazards regression models adjusted for demographics, clinical and access-related variables.
A total of 904 patients with AV access thrombosis (54% arteriovenous fistula, 35% upper arm access) were included, with a mean age of 62 years, 60% were women, 75% had hypertension and 33% had diabetes. Secondary patency was superior after endovascular intervention versus surgical (85% versus 77% at 30 days and 76% versus 69% at 90 days). The adjusted odds of access abandonment within 90 days and 1 year were higher in the surgical thrombectomy group {odds ratio (OR) 1.44 [95% confidence interval (CI) 1.05-1.97] and OR 1.25 (0.94-1.66), respectively}. Results were consistent in the long-term analysis. There was no significant difference in time to next intervention or mortality, and results were consistent within subgroups.
Endovascular intervention was associated with a small short- and long-term benefit as compared with open surgery in haemodialysis patients with AV access thrombosis.
对于动静脉（AV）通路血栓形成，究竟是通过手术还是血管内介入治疗效果最佳，目前尚无共识。我们使用全国血管通路登记处的真实数据，比较了手术与血管内介入治疗 AV 通路血栓形成对通路生存的影响。
我们纳入了 2008 年至 2020 年间瑞典肾脏通路登记处（SRR-Access）中接受首次 AV 通路血栓形成手术或血管内介入治疗的功能型 AV 通路患者。主要结局是通路废弃风险（次要通畅率在 30、60、90 和 365 天）。次要结局是再次干预时间和 30 天死亡率。通过 SRR-Access 获取通路特征，通过瑞典肾脏登记处获取患者特征。采用多变量逻辑回归和 Cox 比例风险回归模型，根据人口统计学、临床和通路相关变量进行调整，评估结局。
共纳入 904 例 AV 通路血栓形成患者（54%为动静脉瘘，35%为上臂通路），平均年龄为 62 岁，60%为女性，75%有高血压，33%有糖尿病。血管内介入治疗后的次要通畅率优于手术治疗（30 天时为 85%比 77%，90 天时为 76%比 69%）。在调整后的 90 天和 1 年内，手术血栓切除术组的通路废弃风险更高[比值比（OR）为 1.44（95%置信区间（CI）为 1.05-1.97）和 OR 为 1.25（0.94-1.66）]。长期分析结果一致。两组之间的再次干预时间或死亡率无显著差异，且亚组分析结果一致。
与开放手术相比，血管内介入治疗在血液透析患者的 AV 通路血栓形成中具有短期和长期的优势。
