【摘要】目的探讨尿激酶局部溶栓联合血管腔内成形术治疗人工血管动静脉内瘘(arteriovenous graft，AVG)早期血栓形成的安全性及有效性。方法选取2017 年1 月～2018 年12 月20 位AVG 早期血栓患者作为研究对象，回顾性分析患者的临床资料，术前均通过血管超声明确AVG 血栓形成，使用尿激酶溶栓后使用注射器经血管鞘反复抽吸血栓，并使用高压球囊推挤残存血栓，并对内瘘狭窄处行球囊扩张，统计手术成功率、手术并发症、随访通畅率等。结果20 例手术取得成功，成功率100%；其中1 例穿刺点血肿，余病例无明显手术并发症。术后3 个月、6 个月及12 个月的初级通畅率分别为80.0%、70.0%、65.0%；次级通畅率分别为100%、100%、95%。结论尿激酶局部溶栓联合血管腔内成形术是治疗人工血管动静脉内瘘早期血栓形成的一种安全有效的方法。
【Abstract】Objective To assess the safety and effectiveness of thrombolysis using urokinase combined with percutaneous transluminal angioplasty in the treatment of acute thrombosis in arteriovenous graft (AVG). Methods The clinical data of 20 patients with acute thrombosis in AVG and treated during the period from January 2017 to December 2018 were retrospectively analyzed. The diagnosis of acute thrombosis in AVG was confirmed by vascular ultrasound examination in all patients. After thrombolysis using urokinase, a syringe was used to repeatedly aspirate the thrombosis via the vascular sheath until no further thrombi could be aspirated, and angioplasty was then performed at the stenosis site as required. Technical success rate, complications and patency rate were analyzed. Results Technical success was achieved in all 20 cases (100 %). One case had hematoma at the puncture site, and the other cases had no complications. Primary patency rates were 100%, 87.5% and 75.0% after 3, 6, and 12 months, respectively. The secondary patency rates were 100%, 100% and 95%, respectively. Conclusions Thrombolysis using urokinase combined with percutaneous transluminal angioplasty in the treatment of acute thrombosis in AVG is safe and effective.
[1]中国医师协会肾脏病医师分会血液透析充分性协作组.中国血液透析充分性临床实践指南[J].中华医学杂志, 2015, 95(34):2748-2753
[2]戴兵, 叶朝阳.更新版血液透析血管通路临床实践建议及研究方向解读 , 2009(9):512-514.[J].中国血液净化, 2009, (9):512-514
[3]Bittl J A.Catheter interventions for hemodialysis fistulas and grafts[J].Jacc Cardiovascular Interventions, 2010, 3(1):1-11
[4]Schild A F, Perez E, Gillaspie E, et al.Arteriovenous fistulae vsarteriovenous grafts: a retrospective review of 1,700 consecutive vascular access cases[J].Journal of Vascular Access, 2008, 9(4):231-
[5]Akoh, Jacob A.Prosthetic Arteriovenous Grafts for Hemodialysis[J].The Journal of Vascular Access, 2009, 10(3):137-147
[6]N Inston, JA Shakarchi, A Khawaja.Maintaining Patency of Vascular Access for Haemodialysis.[J].Cardiovascular Engineering and Technology, Vol.8, September 2017 (3):240–243.
[7]Lee, Timmy, Roy-Chaudhury, et al.Advances and New Frontiers in the Pathophysiology of Venous Neointimal Hyperplasia and Dialysis Access Stenosis[J]. Advances in Chronic Kidney Disease, 16(5):329-338.
[8]Lin C J, Pan C F, Liu H L, et al.The role of protein-bound uremic toxins on peripheral artery disease and vascular access failure in patients on hemodialysis[J].Atherosclerosis, 2012, 225(1):173-179
[9]Roy-Chaudhury, P.Hemodialysis Vascular Access Dysfunction: A Cellular and Molecular Viewpoint[J]. Journal of the American Society of Nephrology, 17(4):1112-1127.
[10]Wu, C.-C, Wen, S.-C, Yang, C.-W, et al. Plasma ADMA Predicts Restenosis of Arteriovenous Fistula[J].Journal of the American Society of Nephrology Jasn, 20(1):213-222.
[11]张明光, 缪健航, 刘池拽, 等.人工血管动静脉内瘘术后狭窄和闭塞的介入治疗[J].中华普通外科学文献电子版, 2017, 11(3):195-196
[12]郭相江, 赵意平, 施娅雪，等.尿激酶溶栓治疗人工血管动静脉内瘘急性血栓形成[J].中国血液净化, 2011, 10(4):198-200
[13]Bermudez, P, Fontsere, N, Mestres G, et al.Endovascular Revascularization of Hemodialysis Thrombosed Grafts with the Hydrodynamic Thrombectomy Catheter[J].our 7- Year Experience. Cardiovasc Intervent Radiol, 2017, 40(2):252-259
[14]Shatsky, Josh B, Berns, Jeffrey S, Clark, Timothy W.I, et al. Single-center Experience with the Arrow-Trerotola Percutaneous Thrombectomy Device in the Management of Thrombosed Native Dialysis Fistulas[J]. Journal of Vascular & Interventional Radiology Jvir, 16(12):1605-1611.
[15]Simoni E, Blitz L, Lookstein R.Outcomes of AngioJet? thrombectomy in hemodialysis vascular access grafts and fistulas: PEARL I Registry[J].Vasc. Access. 2013(14):72–76
[16]吕佳璇，李月红.长期血液透析通路的介入治疗[J].中国血液净化, 2018, 17(11):38-41
[17]赵意平, 郭相江, 施娅雪, 等.高压球囊治疗人工血管动静脉内瘘狭窄的初步体会[J].中国血液净化, 2015, 14(1):25-28
[18]万正东, 宋斌, 雷红卫, 等.人造血管透析通路血栓性狭窄与闭塞的介入治疗探讨[J]. 中国现代医学杂志, 2017(5) :138-140.
[19]马博, 李金勇, 樊雪强, 等.人工血管内瘘血栓形成的处理[J]. 中国血液净化, 2017(7)：494-497.
[20]史亚东, 顾建平, 陈亮, 等.急性人工动静脉内瘘血栓栓塞介入治疗[J].介入放射学杂志, 2017, 11(3):195-196
