Objective To investigate the therapeutic effect of ultrasound-guided percutaneous transluminal angioplasty (PTA) for the treatment of thrombosis in autogenous arteriovenous fistula (AVF). Method, Patients having thrombosis in AVF and treated with ultrasound-guided PTA or open surgery in the Nephrology Department of Taizhou Hospital of Zhejiang Province during January 2016 to November 2020 were retrospectively analyzed. They were followed up for 12 months. Their clinical data, operation-related conditions and complications were recorded. The primary patency rates and secondary patency rates after 3, 6, 9 and 12 months were observed. Result A total of 125 patients with thrombosis in AVF were included in this study, in which 46 patients received ultrasound-guided PTA (PTA group) and 79 patients underwent thrombectomy (surgery group). There were no significant differences in preoperative thrombosis time (t=0.315, P=0.753), anesthesia mode (χ2=2.896, P=0.102), operation time (t=0.183, P=0.885) and success rate (χ2＜0.001, P=1.000) between the two groups. The medical expenses were 14,594.17±4,723.79 yuan in PTA group, significantly higher than that of 6,404.76±5,303.15 yuan in surgery group (t=8.660, P<0.001). There were no significant differences in the primary patency rates after 3 months and 6 months between PTA group and surgery group (after 3 months: 95.65% vs. 91.14%, χ2=2.016, P=0.156; after 6 months: 78.26% vs. 84.81%, χ2=0.352, P=0.553). The primary patency rates after 9 months and 12 months were significantly lower in PTA group than in surgery group (after 9 months: 63.04% vs. 83.54%, χ2=5.787, P=0.016; after 12 months: 58.70% vs. 82.28%, χ2=7.224, P=0.007). The secondary patency rate after 12 months was 97.8% in PTA group and 96.2% in operation group (χ2=0.186, P=0.667). Conclusion In the treatment of patients with thrombosis in AVF, ultrasound-guided PTA is a safe and effective measure, having advantages of prolonged hemodialysis access and saving vascular resources for hemodialysis patients.
LIU Man-Man
,
XU Li-Yun
,
WANG Sha-Sha
,
CHEN Wei-Zhen
. Efficacy of ultrasound-guided percutaneous transluminal angioplasty in the treatment of thrombosis in autogenous arteriovenous fistula[J]. Chinese Journal of Blood Purification, 2022
, 21(06)
: 436
-440
.
DOI: 10.3969/j.issn.1671-4091.2022.06.012
[1]Kukita K, Ohira S, Amano I, et al.2011 update Japanese Society for Dialysis Therapy Guidelines of Vascular Access Construction and Repair for Chronic Hemodialysis[J]. Ther Apher Dial, 2015, 19 Suppl 1: 1-39.
[2]Lok C.E,Huber TS,Lee T,et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update[J].Am J Kidney Dis, 2020, 75(4 Suppl 2):S1-s164
[3]金其庄, 王玉柱, 叶朝阳, 等.中国血液透析用血管通路专家共识 (第2版)[J]. 中国血液净化, 2019, 06: 365-381.
[4]Patel D, Ray C.E,Jr,Lokken R.P,et al. Advanced Stent Graft Treatment of Venous Stenosis Affecting Hemodialysis Vascular Access: Case Illustrations[J].Semin Intervent Radiol, 2016, 33(1):39-45
[5]Smith G.E,Gohil R,Chetter IC. Factors affecting the patency of arteriovenous fistulas for dialysis access[J].J Vasc Surg, 2012, 55(3):849-55
[6]邵泽锋, 何旭, 楼文胜, 等.置管溶栓联合球囊成形术治疗血液透析动静脉内瘘闭塞[J]. 中国介入影像与治疗学, 2016, 01: 7-`10.
[7]Bermudez P, Fontseré N, Mestres G, et al.Endovascular Revascularization of Hemodialysis Thrombosed Grafts with the Hydrodynamic Thrombectomy CatheterOur 7-Year Experience[J].Cardiovasc Intervent Radiol, 2017, 40(2):252-259
[8]Boonsrirat U, Hongsakul K.Pharmacomechanical thrombolysis for the treatment of thrombosed native arteriovenous fistula: a single-center experience[J]. Pol J Radiol, 2014, 79: 363-7.
[9]Belli S, Yabanoglu H, Aydogan C, et al.Surgical interventions for late complications of arteriovenous fistulas[J].Int Surg, 2014, 99(4):467-74
[10]Queeley G.L,Campbell ES,Ali A.A. Assessing the Level of Patient-Specific Treatment Recommendations in Clinical Practice Guidelines for Hemodialysis Vascular Access in the United States[J].Am Health Drug Benefits, 2018, 11(5):223-230
[11]Wang T, Wang S, Gu J, et al.Transcatheter Thrombolysis with Percutaneous Transluminal Angioplasty Using a Trans-Brachial Approach to Treat Thrombosed Arteriovenous Fistulas[J]. Med Sci Monit, 2019, 25: 2727-2734.
[12]Portugaller R.H,Kalmar PI,Deutschmann H. The eternal tale of dialysis access vessels and restenosis: are drug-eluting balloons the solution?[J].J Vasc Access, 2014, 15(6):439-47
[13]Rajan D.K,Sidhu A,Noel-Lamy M,et alElastic Recoil after Balloon Angioplasty in Hemodialysis Accesses: Does It Actually Occur and Is It Clinically Relevant?[J].Radiology, 2016, 279(3):961-7
[14]吴隘红, 黄晓玲, 涂波.超声引导下经皮腔内血管成形术治疗内瘘狭窄与血栓的疗效比较[J].中华肾脏病杂志, 2019, 35(9):702-703
[15]Shah A, Ansari N, Hamadeh Z.Cardiac Arrest Secondary to Bilateral Pulmonary Emboli following Arteriovenous Fistula Thrombectomy: A Case Report with Review of the Literature[J]. Case Rep Nephrol, 2012, 2012: 831726.
[16]Milburn J.A,Ford I,Mutch NJ,et al. Thrombin-anti-thrombin levels and patency of arterio-venous fistula in patients undergoing haemodialysis compared to healthy volunteers: a prospective analysis[J].PLoS One, 2013, 8(7):e67799-
