Trerotola S O, Lund G B, Scheel P J, Savader S J, Venbrux A C, Osterman F A
Department of Radiology, University Hospital, Indiana University Medical Center, Indianapolis 46202-5253.
Radiology. 1994 Jun;191(3):721-6. doi: 10.1148/radiology.191.3.8184052.
To evaluate percutaneous declotting of dialysis access grafts with available catheters without urokinase.
Thirty-four clotted grafts were treated in 24 patients. Clot was macerated and pushed into the central circulation with balloon catheters.
Successful mechanical declotting was performed in all but two patients (94%). The procedure was abandoned after successful declotting in four patients with poor venous outflow, resulting in a 24-hour success rate of 82%. Mean total procedure time was 116 minutes. Eight grafts clotted within 1 week. Using successful dialysis beyond 1 week as the measure of clinical success, the authors report a 59% clinical success rate with mean primary patency of 126 days (range, 16-322 days). Two complications, both emboli to the brachial artery, were successfully treated with urokinase. No symptomatic pulmonary emboli occurred.
Mechanical thrombolysis of clotted grafts with currently available catheters yields results similar to those reported with mechanical devices and urokinase. The procedure is relatively inexpensive, safe, and well tolerated.
评估在不使用尿激酶的情况下，利用现有导管对透析通路移植物进行经皮去凝。
对24例患者的34条血栓形成的移植物进行治疗。用球囊导管将血栓捣碎并推送至中心循环。
除2例患者外，其余所有患者（94%）均成功进行了机械性去凝。4例静脉流出道不佳的患者在成功去凝后放弃了该操作，导致24小时成功率为82%。平均总操作时间为116分钟。8条移植物在1周内再次形成血栓。以超过1周的成功透析作为临床成功的衡量标准，作者报告临床成功率为59%，平均初次通畅时间为126天（范围为16 - 322天）。2例并发症均为肱动脉栓塞，用尿激酶成功治疗。未发生有症状的肺栓塞。
使用现有导管对血栓形成的移植物进行机械溶栓，其结果与使用机械装置和尿激酶所报告的结果相似。该操作相对便宜、安全且耐受性良好。
