Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Ultrasonography, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
J Vasc Access. 2024 Nov;25(6):1904-1910. doi: 10.1177/11297298231191368. Epub 2023 Aug 17.
To investigate the clinical outcomes of indwelling needle-delivered local urokinase thrombolysis, a cost-saving thrombolytic approach, in the treatment of thrombosed arteriovenous grafts (AVGs).
The clinical data of 71 patients with a first episode of thrombosed AVG were analyzed. Among them, 49 patients underwent urokinase thrombolysis and percutaneous transluminal angioplasty (PTA), and 22 patients underwent thrombectomy and PTA. The operation success rate, operation time, perioperative and postoperative complications, primary patency, and secondary patency were compared.
Clinical success was achieved in all 71 PTAs. After thrombolysis, 29 patients achieved complete lysis, and 20 patients achieved partial lysis. All patients achieved thrombus clearance after PTA. The operating room usage time was 37.48 ± 5.33 min for the complete thrombolysis group and 41.70 ± 6.16 min for the incomplete thrombolysis group, and these values were not significantly different (p = 0.853). The operating room usage time of the thrombectomy group was 124.73 ± 5.08 min, which was significantly longer than that of the other groups (p < 0.001). The log-rank test indicated no significant difference in the 90-, 180-, and 360-day primary patency and corresponding secondary patency (all p > 0.05). The Cox regression showed that no significant difference was noted in the changing rate of primary or secondary patency among the groups (all p > 0.05). No major complications occurred in any of the groups, and the difference in the complication incidence was not significant (p = 0.336).
Indwelling needle-delivered urokinase thrombolysis is an acceptable method for the treatment of thrombosed AVGs. Compared with thrombectomy and PTA, thrombolysis and PTA can significantly shorten the time to use the operating room without reducing primary and secondary patency or increasing complications.
为了研究留置针输送局部尿激酶溶栓治疗血栓形成的动静脉移植物（AVG）的临床结果，这是一种节省成本的溶栓方法。
分析了 71 例首次发生血栓形成的 AVG 患者的临床资料。其中 49 例患者接受尿激酶溶栓和经皮腔内血管成形术（PTA）治疗，22 例患者接受血栓切除术和 PTA 治疗。比较手术成功率、手术时间、围手术期和术后并发症、一期通畅率和二期通畅率。
71 例 PTA 均获得临床成功。溶栓后，29 例患者完全溶解，20 例患者部分溶解。所有患者在 PTA 后均清除血栓。完全溶栓组手术室使用时间为 37.48±5.33min，不完全溶栓组为 41.70±6.16min，两组差异无统计学意义（p=0.853）。血栓切除术组的手术室使用时间为 124.73±5.08min，明显长于其他组（p<0.001）。对数秩检验表明，90、180 和 360 天的一期通畅率和相应的二期通畅率无显著差异（均 p>0.05）。Cox 回归显示，各组的一期或二期通畅率变化率无显著差异（均 p>0.05）。各组均未发生重大并发症，并发症发生率无显著差异（p=0.336）。
留置针输送尿激酶溶栓治疗是治疗血栓形成的 AVG 的一种可接受的方法。与血栓切除术和 PTA 相比，溶栓和 PTA 可显著缩短手术室使用时间，而不会降低一期和二期通畅率或增加并发症。
