超声技术辅助人造血管动静脉内瘘血栓的腔内治疗

Endovascular treatment of thrombosis in arteriovenous graft under the guidance of ultrasound

目的血栓形成导致内瘘闭塞为人造血管动静脉内瘘(arteriovenous graft,AVG)常见的并发症之一,本文总结超声辅助下进行人造血管动静脉内瘘血栓的腔内治疗的有效率及治疗经验。方法回顾2014年1月~2017年6月在北京大学第三医院海淀院区肾内科因人造血管动静脉内瘘闭塞治疗患者共148例。超声辅助人造血管动静脉内瘘血栓腔内治疗患者共78例;超声辅助人造血管动静脉内瘘血栓形成切开手术治疗患者共70例。对比2组治疗手术成功率,手术时间,手术创伤,及术后3个月、6个月干预后初始通畅率(postintervention primary patency)^([1])。结果超声辅助人造血管动静脉内瘘血栓腔内治疗患者共78例,成功74例;超声辅助人造血管动静脉内瘘血栓形成切开手术治疗患者共70例,成功68例。切开取栓组和腔内治疗组手术成功率分别为97%和95%。腔内治疗组手术时间(74.95±5.78)min短于切开取栓组(109.6±7.85)min(P=0.001,t=3.55)。腔内治疗组手术创伤明显小于切开取栓组。术后3个月切开取栓组和腔内治疗组干预后初始通畅率(postintervention primary patency)分别为85%±2%和84%±1%(P=0.290,t=0.580)。术后6个月切开取栓组和腔内治疗组干预后初始通畅率分别为75%±2%和73%±1%(P=0.370,t=0.340)。2组患者均未发生严重并发症。结论超声辅助人造血管动静脉内瘘血栓腔内治疗安全、微创、有效。

Objective Fistula occlusion caused by thrombosis is one of the common arteriovenous graft （AVG） complications. This article summarizes the success rate and our experiences about endovascular treat- ment of thrombosis in AVG under the guidance of ultrasound. Methods A total of 148 patients with AVG thrombosis were treated in our hospital in the period from Jan. 2014 to Jun. 2017, including 78 patients using ultrasound assisted endovascular treatment and 70 patients using ultrasound assisted incision treatment. The two groups were compared for success rate, operation time, surgical trauma and primary patency after the in- tervention for 3 and 6 months. Results Ultrasound assisted endovascular treatment and ultrasound assisted incision treatment effectively resolved the AVG thromboses in 74 of the 78 patients （95%） and 68 of the 70 pa- tients （97%）, respectively. The operation time was 74.95±5.78rain for endovascular treatment patients, and was 109.6±7.85min for incision and thrombectomy patients （t=-3.55, P=0.001）. The surgical trauma was less in endovascular treatment patients than in incision and thrombectomy patients. The primary patency rates in endovascular treatment patients and incision and thrombectomy patients were 84±1% and 85±2%, respective- ly, after the operation for 3 months （t=-0.58, P=0.29）, and were 73±1% and 75±2%, respectively, after the oper- ation for 6 months （t=-0.34,P=0.37）. No serious complications occurred in the two groups. Conclusion En- dovascular treatment of thrombosis in AVG under the guidance of ultrasound is a safe, minimally invasive and effective method.