Schuman E, Quinn S, Standage B, Gross G
Department of Surgery, Good Samaritan Hospital, Portland, Oregon.
Am J Surg. 1994 May;167(5):473-6. doi: 10.1016/0002-9610(94)90237-2.
Graft thrombosis is the most frequent complication of polytetrafluoroethylene grafts for hemodialysis. Many of these patients arrive at the dialysis unit with fluid and metabolic abnormalities that require prompt dialysis. Rapid declotting of the graft is important to avoid having to create temporary access. Thrombolysis with urokinase has been evaluated by recent retrospective studies and found to be successful in 60% to 90% of cases. Our prospective, randomized trial was initiated to compare thrombolysis with standard surgical thrombectomy; and to evaluate the safety, effectiveness, efficiency, and durability of these modalities. In this study, 15 patients underwent thrombolysis and 16 had thrombectomy. The success rate was 67% for the thrombolysis group compared with 94% for the surgical group. Patency rates were similar for both modalities, but the complication rates were higher and the time to completion longer with thrombolysis. Although both treatments can be used successfully, surgical thrombectomy remains the optimal choice for treating occluded dialysis grafts.
移植血管血栓形成是血液透析用聚四氟乙烯移植血管最常见的并发症。许多此类患者到达透析单元时伴有液体和代谢异常，需要立即进行透析。迅速清除移植血管内的血栓对于避免建立临时血管通路很重要。近期的回顾性研究评估了用尿激酶进行溶栓治疗的效果，发现60%至90%的病例治疗成功。我们开展了前瞻性随机试验，以比较溶栓治疗与标准外科血栓切除术；并评估这些治疗方式的安全性、有效性、效率和耐用性。在本研究中，15例患者接受了溶栓治疗，16例接受了血栓切除术。溶栓组的成功率为67%，而手术组为94%。两种治疗方式的通畅率相似，但溶栓治疗的并发症发生率更高，完成治疗所需时间更长。虽然两种治疗方法都能成功应用，但外科血栓切除术仍是治疗闭塞性透析移植血管的最佳选择。
