Hellwig Konstantin, Zicha Stefan, Kopp Christoph, Rother Ulrich, Papatheodorou Nikolaos, Uder Michael, Schmid Axel
Institute of Radiology, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Maximiliansplatz 3, 91054, Erlangen, Germany.
Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nuremberg, 91054, Erlangen, Germany.
Cardiovasc Intervent Radiol. 2025 Apr;48(4):450-457. doi: 10.1007/s00270-024-03897-5. Epub 2024 Nov 18.
The necessity of providing endovascular recanalization of acutely thrombosed arteriovenous access (AV access) during weekend is questionable, since hemodialysis can alternatively be achieved by temporarily placed non-tunneled central venous catheters (CVC). Interventional therapy of acutely thrombosed AV access is provided only on weekdays in the study center. This study aimed to compare outcomes in patients admitted on weekdays and on the weekend.
A total of 355 endovascular procedures for thrombosed AV access performed in a single tertiary center from 2007 to 2017 were retrospectively analyzed for technical and clinical success, complications, rate of CVC and length of hospitalization. Technical success was defined as adequate blood flow with less than 30% residual stenosis, clinical success was defined as at least one successful hemodialysis after recanalization. There were two groups: patients who had to wait at least 2 days for recanalization due to admission at the weekend (n = 59, at-the-weekend group, ATW group) and patients receiving therapy no later than the day after admission (n = 296, on a working day group, OAW group).
The technical/clinical success rate was 96.6%/88.1% in the ATW and 89.1%/84.6% in the OAW group (p > .05). Complications did not differ among groups (p > .05). Despite a higher rate of CVC, no attributed additional adverse events or complications were observed in the ATW group (p > .05).
Despite a longer time until treatment and a higher rate of short-term CVC, it seems to be justified to provide recanalization of dialysis shunts only during weekdays.
在周末进行急性血栓形成的动静脉内瘘（AV内瘘）血管腔内再通的必要性存在疑问，因为通过临时放置的非隧道式中心静脉导管（CVC）也可实现血液透析。研究中心仅在工作日提供急性血栓形成的AV内瘘的介入治疗。本研究旨在比较工作日和周末入院患者的治疗结果。
回顾性分析2007年至2017年在单个三级中心进行的355例血栓形成的AV内瘘血管腔内手术的技术和临床成功率、并发症、CVC使用率及住院时间。技术成功定义为血流量充足且残余狭窄小于30%，临床成功定义为再通后至少有一次成功的血液透析。分为两组：因周末入院而至少等待2天进行再通的患者（n = 59，周末组，ATW组）和入院后不迟于次日接受治疗的患者（n = 296，工作日组，OAW组）。
ATW组的技术/临床成功率分别为96.6%/88.1%，OAW组为89.1%/84.6%（p > 0.05）。各组并发症无差异（p > 0.05）。尽管ATW组CVC使用率较高，但未观察到归因于此的额外不良事件或并发症（p > 0.05）。
尽管治疗前等待时间较长且短期CVC使用率较高，但似乎仅在工作日进行透析分流再通是合理的。
