Weiss Ryan, Yu Qian, Funaki Brian, Hammes Mary
Department of Internal Medicine, Section of Nephrology, University of Chicago Medical Center, Chicago, IL, USA.
Department of Radiology, Section of Vascular and Interventional Radiology, University of Chicago Medical Center, Chicago, IL, USA.
J Vasc Access. 2025 Jul;26(4):1249-1256. doi: 10.1177/11297298241260755. Epub 2024 Aug 9.
Thrombosis of the vascular access in patients with end-stage renal disease requiring hemodialysis are common and require timely interventional procedures to restore patency. The aim of the current study was to identify factors having a significant effect on patency rates after access thrombosis. Our hypothesis was the length of time between the initial clotting of the access and the subsequent percutaneous declotting impacts the patency rates of the vascular access.
In this retrospective cohort study, patients with a clotted arteriovenous access between Jan 1, 2011, and Jan 1, 2016, were included. Demographics, access history, and associated details of the access procedure were reviewed from the electronic medical record. Statistical analysis was done using -test and chi-square or fisher exact tests to compare arteriovenous fistulae (AVF) and arteriovenous grafts (AVG). Primary patency, defined as the time from index procedure to endpoint, was analyzed using the Kaplan-Meier method and log rank test.
There were 883 percutaneous declotting procedures reviewed. About 351 procedures were performed in patients with an AVF and 532 with an AVG. The mean time from thrombosis to declotting was 1.71 ± 2.29 days. The overall median primary patency for both AVF and AVG was 43 days with no difference in patency between patients with AVF (39 days) versus AVG (42 days; = 0.385). The time period from access thrombosis to declotting did not affect patency rates for either AVG or AVF ( = 0.385). On multivariable analysis, prior intervention (HR: 1.32, 95% CI: 1.14-1.53, < 0.001) and cardiovascular disease (HR: 1.19, 95% CI: 1.03-1.37, = 0.016) were independently associated with access patency.
Time from thrombosis to declotting did not affect patency rates however once there was a thrombotic event, recurrent thrombosis requiring intervention was common with patency significantly decreased. Future prospective studies to validate our results and study pathogenic mechanisms of recurrent thrombosis are warranted.
对于需要血液透析的终末期肾病患者，血管通路血栓形成很常见，需要及时采取介入措施以恢复通畅。本研究的目的是确定对通路血栓形成后通畅率有显著影响的因素。我们的假设是，通路初次凝血与随后的经皮清除血栓之间的时间长度会影响血管通路的通畅率。
在这项回顾性队列研究中，纳入了2011年1月1日至2016年1月1日期间动静脉通路发生血栓形成的患者。从电子病历中回顾了人口统计学、通路病史以及通路手术的相关细节。使用t检验、卡方检验或费舍尔精确检验进行统计分析，以比较动静脉内瘘（AVF）和动静脉移植物（AVG）。主要通畅率定义为从索引手术到终点的时间，使用Kaplan-Meier方法和对数秩检验进行分析。
共回顾了883例经皮清除血栓手术。其中，AVF患者进行了约351例手术，AVG患者进行了532例手术。从血栓形成到清除血栓的平均时间为1.71±2.29天。AVF和AVG的总体主要通畅率中位数均为43天，AVF患者（39天）与AVG患者（42天；P = 0.385）的通畅率无差异。从通路血栓形成到清除血栓的时间段对AVG或AVF的通畅率均无影响（P = 0.385）。多变量分析显示，既往干预（HR：1.32，95%CI：1.14 - 1.53，P < 0.001）和心血管疾病（HR：1.19，95%CI：1.03 - 1.37，P = 0.016）与通路通畅独立相关。
从血栓形成到清除血栓的时间不影响通畅率，然而一旦发生血栓事件，需要干预的复发性血栓形成很常见，且通畅率显著降低。有必要进行未来的前瞻性研究以验证我们的结果并研究复发性血栓形成的致病机制。
