Department of Radiology, University Hospitals KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.
Cardiovasc Intervent Radiol. 2023 Sep;46(9):1162-1167. doi: 10.1007/s00270-023-03434-w. Epub 2023 Apr 13.
Thrombotic occlusion of autologous arteriovenous fistulas or synthetic arteriovenous grafts is a serious adverse event in hemodialysis patients and declotting should be performed before next hemodialysis session, in order to avoid a central venous catheter. Various techniques exist to declot a thrombosed vascular access, including open surgical thrombectomy, catheter-directed thrombolysis and use of different types of percutaneous thrombo-aspiration catheters and mechanical thrombectomy devices. These devices can be categorized as devices with direct wall contact and hydrodynamic devices without direct wall contact. Technical and early clinical outcome results of percutaneous hemodialysis declotting are high and ranging between 70 and 100%; late clinical patency results are much lower related to restenosis or re-thrombosis; these patency results are higher for autologous arteriovenous fistulas compared to synthetic arteriovenous grafts and mainly depend on the combined efficacy of successful thrombectomy and durable treatment of the underlying stenoses, associated with the acute thrombosis.
自体动静脉瘘或合成动静脉移植物的血栓闭塞是血液透析患者的严重不良事件，应在下一次血液透析治疗前进行溶栓，以避免使用中心静脉导管。存在多种技术可用于溶栓，包括开放性手术取栓、导管内溶栓以及使用不同类型的经皮血栓抽吸导管和机械血栓切除术装置。这些装置可分为直接接触血管壁的装置和无直接血管壁接触的水力装置。经皮血液透析溶栓的技术和早期临床结果非常高，范围在 70%到 100%之间；晚期临床通畅率结果要低得多，与再狭窄或再血栓形成有关；与合成移植物相比，自体动静脉瘘的通畅率更高，主要取决于成功取栓和对急性血栓形成相关的基础狭窄的持久治疗的综合效果。
