DiFatta Jake, Mahler Chase, Huang Junjian, Gunn A J, Raja Junaid
School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Division of Vascular and Interventional Radiology/Department of Radiology, University of Alabama at Birmingham, 625 19Th St S, Suite 484, Birmingham, AL, 35233, USA.
Cardiovasc Intervent Radiol. 2025 Jun 9. doi: 10.1007/s00270-025-04070-2.
PURPOSE: To investigate the safety and efficacy of pharmacomechanical intervention in the maintenance of pediatric dialysis access fistulas and grafts in the extremities. MATERIALS AND METHODS: A retrospective analysis of 67 interventions performed on 17 pediatric patients with dialysis access maintenance interventions was conducted. Use of angioplasty, stenting, thrombectomy devices, and thrombolytic agents such as tissue plasminogen activator (tPA) were recorded across interventions. Total number of interventions per patient and time between reinterventions were measured. Safety of these techniques was assessed according to the Cardiovascular and Interventional Radiology Society of Europe (CIRSE) complication guidelines. Technical success was defined as restoration of patency without a hemodynamically significant stenosis, and clinical success was defined as symptom resolution without reintervention of greater than 6 months. RESULTS: The application of pharmacomechanical intervention demonstrated a favorable safety profile and high technical success rates across all categories. The median age at first intervention was 13 years (IQR 10.1-16.9, range 7-18), and median number of interventions was 2 with a range of 1-11. No major complications were observed during or after the procedures. Among the 67 interventions, angioplasty was the most frequently employed technique (n = 67, 100%), followed by thrombolysis and/or anticoagulation (n = 34, 50.7%), thrombectomy (n = 21, 31.3%), and stenting (n = 10, 14.9%). Technical success was 98.5% (66/67), and combined 6-month primary assisted and secondary patency from the index dialysis circuit intervention was 41.8% (28/67). For patients who received more than one treatment, median time to reintervention was 107 days. CONCLUSION: The high rate of technical success and absence of major or minor complications suggest that endovascular techniques for dialysis access maintenance including angioplasty, stenting, thrombolysis, and advances therapies can be safely and effectively performed in pediatric patients. Rates of primary and secondary patency are slightly lower compared to the adult population. LEVEL OF EVIDENCE: Level 4, Retrospective Cohort Study.
目的：探讨药物机械干预在维持小儿肢体透析通路动静脉内瘘及移植物中的安全性和有效性。 材料与方法：对17例接受透析通路维持干预的儿科患者进行的67次干预进行回顾性分析。记录各干预中血管成形术、支架置入术、血栓切除术器械以及组织纤溶酶原激活剂（tPA）等溶栓药物的使用情况。测量每位患者的干预总数以及再次干预之间的时间间隔。根据欧洲心血管和介入放射学会（CIRSE）并发症指南评估这些技术的安全性。技术成功定义为恢复通畅且无血流动力学意义上的明显狭窄，临床成功定义为症状缓解且无需再次干预超过6个月。 结果：药物机械干预的应用在所有类别中均显示出良好的安全性和较高的技术成功率。首次干预时的中位年龄为13岁（四分位间距10.1 - 16.9，范围7 - 18岁），干预的中位次数为2次，范围为1 - 11次。手术期间或术后未观察到重大并发症。在67次干预中，血管成形术是最常用的技术（n = 67，100%），其次是溶栓和/或抗凝（n = 34，50.7%）、血栓切除术（n = 21，31.3%）和支架置入术（n = 10，14.9%）。技术成功率为98.5%（66/67），首次透析回路干预后的6个月联合初级辅助和次级通畅率为41.8%（28/67）。对于接受多次治疗的患者，再次干预的中位时间为107天。 结论：较高的技术成功率以及无重大或轻微并发症表明，包括血管成形术、支架置入术、溶栓和先进疗法在内的用于透析通路维持的血管内技术可在儿科患者中安全有效地进行。与成人相比，初级和次级通畅率略低。 证据水平：4级，回顾性队列研究。
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