Jahn C, Lebras Y, Mutter D, Petitjean P, Roy C, Schnitzler B, Dimitrov Y
Service de Radiologie, Chirurgie A, ULP Strasbourg.
Nephrologie. 1994;15(2):145-50.
Several techniques (surgical revision, thrombectomy, ...) have been described for the treatment of thrombosed vascular access (VA) in hemodialysis patients. We propose a technique with local thrombolytic infusion in conjunction with angiography and percutaneous dilatation and/or recanalization. A total of fourteen patients with twenty-two episodes of thrombosed VA was studied. Eleven patients had a Brescia-Cimino fistula and three patients had a graft fistula. We used in 21 cases urokinase (243000 UI +/- 100000 UI) and in 1 case rt-PA (50 mg). Of the 22 VA, 19 issued in an immediate patency and were restored to full function; and whereof 17 remained patent more than 2 weeks. Failures occurred in 3 cases: localized bleeding from previous dialysis puncture sites (1), venous outflow obstruction (1), and resistant venous stenosis (1). There were no infectious complications, and no systemic bleeding complications. We observed one pseudoaneurysm and one humeral asymptomatic thrombo-embolism. Stenoses were the most frequent factor in precipitating thrombosis. We believe that our technique should be the first line of treatment of occluded hemodialysis vascular access.
已经描述了几种治疗血液透析患者血栓形成的血管通路（VA）的技术（手术修复、血栓切除术等）。我们提出一种局部溶栓输注联合血管造影及经皮扩张和/或再通的技术。共研究了14例患者的22次血栓形成的VA发作。11例患者有布雷西亚-西米诺内瘘，3例患者有人造血管内瘘。21例使用尿激酶（243000 UI±100000 UI），1例使用rt-PA（50 mg）。22条VA中，19条立即通畅并恢复了全部功能；其中17条在2周以上保持通畅。3例出现失败：既往透析穿刺部位局部出血（1例）、静脉流出道梗阻（1例）和顽固性静脉狭窄（1例）。没有感染并发症，也没有全身性出血并发症。我们观察到1例假性动脉瘤和1例肱骨无症状血栓栓塞。狭窄是引发血栓形成的最常见因素。我们认为我们的技术应该是闭塞性血液透析血管通路的一线治疗方法。
