Krysl J, Kumpe D A
Department of Radiology, University of Colorado Health Sciences Center, Denver, USA.
Semin Vasc Surg. 1997 Sep;10(3):175-83.
Chronic dialysis access is plagued with the formation of stenoses and access thrombosis, with a thrombosis rate of 0.5 to 0.8 episodes per year. Surgical management of thrombosed accesses, including thrombectomy, patch angioplasty, and bypass, has been the traditional treatment for thrombosed grants. Percutaneous catheter-directed thrombolysis of thrombosed accesses, coupled with angioplasty of underlying stenoses, offers comparable results to surgical revascularization. The technical success of thrombolysis is between 75% and 92%, similar to surgical results, with the advantage of sparing vein as potential conduit for future access sites. Surgical therapy may successfully reestablish access function for those stenoses that fail angioplasty. Long-term patencies after a single revascularization procedure are poor (median patency, < 90 days) for both catheter-directed and surgical procedures, and repeat maintenance procedures are necessary. Access surveillance using various means with timely fistulography coupled with angioplasty of stenoses has been shown to decrease the rate of access thromboses by a factor of 3 and to increase patency of grafts. A combined approach with catheter-directed therapies and surgical interventions leads to maximal longevity of each access site.
长期透析通路常受狭窄形成和通路血栓形成的困扰，每年血栓形成率为0.5至0.8次发作。血栓形成通路的手术治疗，包括血栓切除术、补片血管成形术和旁路手术，一直是血栓形成通路的传统治疗方法。经皮导管定向溶栓治疗血栓形成通路，再加上对潜在狭窄进行血管成形术，其效果与手术血运重建相当。溶栓的技术成功率在75%至92%之间，与手术结果相似，优点是保留静脉作为未来通路部位的潜在管道。对于血管成形术失败的狭窄，手术治疗可能成功重建通路功能。对于导管定向和手术操作，单次血运重建术后的长期通畅率都很差（中位通畅时间，<90天），因此需要重复进行维持操作。使用各种方法进行通路监测，并及时进行瘘管造影和狭窄血管成形术，已被证明可将通路血栓形成率降低三分之一，并提高移植物的通畅率。导管定向治疗和手术干预相结合的方法可使每个通路部位的使用寿命最长。
