Roberts A C, Valji K, Bookstein J J, Hye R J
Department of Radiology, University of California San Diego Medical Center.
Am J Surg. 1993 Aug;166(2):221-5; discussion 225-6. doi: 10.1016/s0002-9610(05)81060-8.
The results of pulse-spray pharmacomechanical thrombolysis (PSPMT) of 209 thrombosed hemodialysis grafts were reviewed. In PSPMT, concentrated urokinase is injected forcefully through catheters with multiple tiny sideholes or sideslits. Catheters placed in a crisscross fashion cover the entire clot simultaneously. This therapy was successful in treating patients with thrombosed grafts. Of the 200 grafts with complete therapy, 197 grafts (99%) were patent at the end of the procedure. Mean time for pulsed-spray lysis was 40 minutes. Etiologies for graft thrombosis were anastomotic venous outflow stenosis, stenosis of the venous outflow away from the anastomosis, arterial stenosis, intragraft stenosis, pseudoaneurysms, and no identifiable cause in a small percentage. There were 16 complications, 8 of which required additional therapy or potentially compromised the graft. These results suggest that pharmacomechanical thrombolysis and angioplasty provide rapid, consistent, and safe recanalization of thrombosed hemodialysis grafts and represent an additional therapeutic approach to graft management.
回顾了209例血栓形成的血液透析移植物的脉冲喷射药物机械溶栓（PSPMT）结果。在PSPMT中，将浓缩尿激酶通过带有多个微小侧孔或侧缝的导管强力注入。以交叉方式放置的导管可同时覆盖整个血栓。该疗法成功治疗了血栓形成的移植物患者。在200例接受完整治疗的移植物中，197例（99%）在手术结束时保持通畅。脉冲喷射溶栓的平均时间为40分钟。移植物血栓形成的病因包括吻合口静脉流出道狭窄、远离吻合口的静脉流出道狭窄、动脉狭窄、移植物内狭窄、假性动脉瘤，以及一小部分原因不明的情况。共有16例并发症，其中8例需要额外治疗或可能危及移植物。这些结果表明，药物机械溶栓和血管成形术可快速、持续且安全地使血栓形成的血液透析移植物再通，是移植物管理的另一种治疗方法。
