机械吸栓与切开取栓治疗动静脉移植物内瘘急性血栓形成的效果比较

Comparison of percutaneous mechanical thrombectomy and surgical thrombectomy in the treatment of acute arteriovenous graft thrombosis

目的比较经皮机械吸栓与传统切开取栓治疗动静脉移植物内瘘(AVG)急性血栓形成的效果。方法回顾性分析2020年1月至2021年12月于上海交通大学医学院附属仁济医院血管外科治疗的AVG急性血栓形成患者的临床资料,根据治疗方式分为机械吸栓组和切开取栓组,比较两组患者的基础资料、技术成功率、并发症发生率,以及术后24个月的初级通畅率和次级通畅率。结果共纳入130例患者,其中男66例,女64例,年龄(54.1±14.2)岁,机械吸栓组78例,切开取栓组52例。两组患者性别、年龄、合并症及病变情况差异均无统计学意义(均P>0.05)。机械吸栓组的技术成功率为98.7%(77/78),并发症发生率为5.1%(4/78);切开取栓组的技术成功率为94.2%(49/52),并发症发生率为9.6%(5/52)。两组患者的技术成功率、并发症发生率差异均无统计学意义(均P>0.05)。机械吸栓组的手术时间短于切开取栓组[(62.8±13.9)min比(77.0±17.6)min,P<0.001]。Kaplan-Meier生存分析结果显示,机械吸栓组术后12、24个月的初级通畅率分别为62.8%、38.5%,切开取栓组则分别为57.7%、36.5%,两组患者初级通畅率差异无统计学意义(P=0.641)。机械吸栓组术后12、24个月的次级通畅率分别为98.7%、94.9%,切开取栓组则分别为92.3%、82.7%,机械吸栓组的次级通畅率高于切开取栓组(P=0.020)。结论机械吸栓治疗AVG急性血栓形成安全有效,与切开取栓相比手术时间较短、次级通畅率较高。

Objective To compare the efficacy between percutaneous mechanical thrombectomy and surgical thrombectomy in the treatment of acute arteriovenous graft thrombosis(AVG).Methods The clinical data of acute thrombosis AVG patients treated in the Department of Vascular Surgery,Renji Hospital,School of Medicine,Shanghai Jiao Tong University from January 2020 to December 2021 were retrospectively analyzed.Patients were divided into percutaneous mechanical thrombectomy group and surgical thrombectomy group according to treatment methods.Baseline information,technical success rate,complication rate,and 24-month primary and secondary patency rates of the two groups were analyzed.Results A total of 130 patients aged(54.1±14.2)years were enrolled in the study,including 66 males and 64 females.There were 78 patients in the percutaneous mechanical thrombectomy group and 52 patients in surgical thrombectomy group.No statistically significant differences in gender,age,comorbidities,and lesion characteristics between the two groups were detected(all P>0.05).The technical success rate in the mechanical thrombectomy group was 98.7%(77/78),and the complication rate was 5.1%(4/78),while the technical success rate in the surgical thrombectomy group was 94.2%(49/52),and the complication rate was 9.6%(5/52).There were no statistically significant differences in the technical success rate and complication rate between the two groups(all P>0.05).The average operation time of mechanical thrombectomy was significantly shorter than that of surgical thrombectomy[(62.8±13.9)min vs(77.0±17.6)min,P<0.001].The Kaplan-Meier survival analysis indicated the primary patency rates of the mechanical thrombectomy group at 12 and 24 months after thrombectomy were 62.8%and 38.5%,respectively,while the primary patency rates of the surgical thrombectomy group at 12 and 24 months were 57.7%and 36.5%,respectively.There was no statistically significant difference in the primary patency rate between the two groups(P=0.641).The secondary patency rates of the mechanical thrombectomy group at 12 and 24 months were 98.7%and 94.9%,respectively,while the secondary patency rates of the surgical thrombectomy group at 12 and 24 months were 92.3%and 82.7%,respectively.The secondary patency rates of the mechanical thrombectomy group were higher than those of the surgical thrombectomy group(P=0.020).Conclusion Mechanical thrombectomy is a safe and effective treatment for acute AVG thrombosis,with the advantages of shorter operation time and higher secondary patency rate compared with surgical thrombectomy.