Uflacker R, Rajagopalan P R, Vujic I, Stutley J E
Department of Radiology, Medical University of South Carolina, Charleston 29425-9737, USA.
J Vasc Interv Radiol. 1996 Mar-Apr;7(2):185-92. doi: 10.1016/s1051-0443(96)70760-1.
To report the preliminary results in a trial comparing the Amplatz mechanical thrombectomy (MT) device with surgical thrombectomy (ST) to declot occluded dialysis access grafts.
Thirty-seven patients were randomly assigned by computer to either ST (n = 18) or MT (n = 19). Diagnostic fistulograms were obtained at the end of the procedure, and Doppler ultrasound was performed at 1-month follow-up. Plasma free hemoglobin levels were measured before, immediately after, and 24 hours after the procedure in the MT group. Success was defined as initial success with restoration of flow through the graft, primary patency at 30 days, and secondary patency at 30 days.
Technical success with MT was 89%. Primary patency in the MT series was 47% and secondary 30-day patency was 68%. Technical success with ST was 83%. Primary patency in the ST series was 77% and secondary patency at 30 days was 77%. Angioplasty (n = 18) and stent placement (n = 6) were performed in the MT cases. Angioplasty was impossible in one patient. Immediately after MT, plasma free hemoglobin levels above normal were noted in 63% of the cases, but these levels were within normal levels after 24 hours in 88% of the cases.
Initial success of MT in patients with occluded dialysis access grafts is comparable to that of ST. No statistically significant differences in primary or secondary patencies were seen.
报告一项对比Amplatz机械血栓切除术（MT）与外科血栓切除术（ST）以清除阻塞性透析通路移植物血栓的试验的初步结果。
37例患者通过计算机随机分为ST组（n = 18）或MT组（n = 19）。在手术结束时进行诊断性动静脉造影，并在1个月随访时进行多普勒超声检查。在MT组中，于手术前、术后即刻及术后24小时测量血浆游离血红蛋白水平。成功定义为移植物血流恢复的初始成功、30天的初级通畅率以及30天的次级通畅率。
MT的技术成功率为89%。MT组的初级通畅率为47%，30天的次级通畅率为68%。ST的技术成功率为83%。ST组的初级通畅率为77%，30天的次级通畅率为77%。MT病例中进行了血管成形术（n = 18）和支架置入术（n = 6）。1例患者无法进行血管成形术。MT术后即刻，63%的病例血浆游离血红蛋白水平高于正常，但88%的病例在24小时后这些水平恢复正常。
MT在阻塞性透析通路移植物患者中的初始成功率与ST相当。在初级或次级通畅率方面未观察到统计学上的显著差异。
