Middlebrook M R, Amygdalos M A, Soulen M C, Haskal Z J, Shlansky-Goldberg R D, Cope C, Pentecost M J
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
Radiology. 1995 Jul;196(1):73-7. doi: 10.1148/radiology.196.1.7784593.
To compare a technique of mechanical balloon declotting of thrombosed hemodialysis grafts with conventional pulsed-spray thrombolysis.
Forty patients had 53 episodes of graft thrombosis over a 19-month period. Twenty-nine grafts were randomly treated with thrombolysis with urokinase and 24 grafts with mechanical declotting by placement of crossed balloon catheters within the graft. Patency was determined by retrospective review of hemodialysis records.
Successful hemodialysis for 1 week after the procedure was achieved in 21 (88%) of the 24 grafts treated mechanically and 26 (90%) of 29 grafts treated with thrombolysis. Continuous pulse oximetry showed no change in oxygen saturation in either group, and no clinical signs or symptoms of pulmonary embolism were noted. Average total procedure times were 2.2 hours for mechanical declotting and 3.5 hours for thrombolysis (P < .05). Probability of patency (mechanical vs thrombolysis) was 42% vs 45% at 3 months, 36% vs 25% at 6 months, and 8% vs 4% at 12 months. One major complication of ulnar artery embolization occurred in the thrombolysis group.
Mechanical declotting of hemodialysis grafts is faster and as effective as thrombolysis.
比较机械性球囊清除血栓形成的血液透析移植物技术与传统脉冲喷射溶栓术。
40例患者在19个月期间发生53次移植物血栓形成。29个移植物随机接受尿激酶溶栓治疗，24个移植物通过在移植物内放置交叉球囊导管进行机械性血栓清除。通过回顾性分析血液透析记录来确定通畅情况。
接受机械治疗的24个移植物中有21个（88%）在术后1周成功进行了血液透析，接受溶栓治疗的29个移植物中有26个（90%）成功进行了血液透析。连续脉搏血氧饱和度监测显示两组患者的血氧饱和度均无变化，且未观察到肺栓塞的临床体征或症状。机械性血栓清除的平均总操作时间为2.2小时，溶栓治疗为3.5小时（P <.05）。3个月时通畅概率（机械治疗组与溶栓治疗组）分别为42%和45%，6个月时分别为36%和25%，12个月时分别为8%和4%。溶栓治疗组发生1例尺动脉栓塞的主要并发症。
血液透析移植物的机械性血栓清除速度更快，且与溶栓治疗效果相同。
