Zhou Yu, Lyu Qiong, Lai Qiquan, Gao Xuejing, Chen Ling, Zhang Xi, Wan Ziming
Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
Int J Nephrol Renovasc Dis. 2025 Jul 14;18:215-227. doi: 10.2147/IJNRD.S527885. eCollection 2025.
Urokinase thrombolysis is a feasible method for salvage of thrombosed arteriovenous fistulas (AVFs). The impact of optimizing thrombolysis outcomes on improving the efficacy of subsequent angioplasty remains unclear. This study is aimed to investigate the impact of thrombolysis outcomes and to identify the prognostic factors of thrombolysis.
The patients were divided into a complete lysis (CL) group of 336 treatments, an incomplete lysis (IL) group of 83 treatments, and a lysis failure (LF) group of 206 treatments. The efficacy data of the subsequent angioplasty and the patency before the next intervention were compared. Demographics, fistula characteristics, and baseline serum parameters were compared to screen for prognostic factors of thrombolysis outcomes.
As the degree of thrombolytic therapy decreased, the complication rate significantly increased (CL, 14.6%; IL, 21.7%; LF, 30.6%; trend P < 0.001), whereas the clinical success rate of angioplasty decreased (CL, 97.0%; IL, 94.0%; LF, 82.3%; trend P < 0.001). However, no difference was noted in the patency interval before the next intervention among the three groups (log-rank P = 0.562). Elbow AVF and hemoglobin < 115 g/L were risk factors of poor lysis outcomes. The complete lysis rate of patients with both factors was 24.2%, whereas the rates of patients with one or neither factor were significantly higher (all > 50% and P = 0.001).
Complete thrombolysis is beneficial for improving the efficacy of recanalization procedures for thrombosed AVFs. Non-elbow AVFs and hemoglobin ≥115 g/L are predictors of an increased complete lysis rate.
尿激酶溶栓是挽救血栓形成的动静脉内瘘（AVF）的一种可行方法。优化溶栓结果对提高后续血管成形术疗效的影响尚不清楚。本研究旨在调查溶栓结果的影响并确定溶栓的预后因素。
患者被分为336次治疗的完全溶解（CL）组、83次治疗的不完全溶解（IL）组和206次治疗的溶解失败（LF）组。比较了后续血管成形术的疗效数据和下次干预前的通畅情况。比较了人口统计学、瘘管特征和基线血清参数，以筛选溶栓结果的预后因素。
随着溶栓治疗程度降低，并发症发生率显著增加（CL组为14.6%；IL组为21.7%；LF组为30.6%；趋势P<0.001），而血管成形术的临床成功率降低（CL组为97.0%；IL组为94.0%；LF组为82.3%；趋势P<0.001）。然而，三组下次干预前的通畅间隔无差异（对数秩检验P=0.562）。肘部AVF和血红蛋白<115 g/L是溶栓结果不佳的危险因素。同时具有这两个因素的患者的完全溶解率为24.2%，而具有一个或没有这两个因素的患者的完全溶解率显著更高（均>50%且P=0.001）。
完全溶栓有利于提高血栓形成的AVF再通手术的疗效。非肘部AVF和血红蛋白≥115 g/L是完全溶解率增加的预测因素。
