超声引导下局部溶栓联合PTA在AVF血栓形成中的应用

Application of ultrasound-guided local thrombolysis combined with PTA for AVF thrombosis

目的探讨超声引导下尿激酶局部溶栓联合经皮血管成形术(PTA)治疗自体动静脉内瘘(AVF)血栓形成的安全性和有效性。方法纳入2018年9月至2021年3月在该院治疗的AVF血栓形成患者共47例,采用超声引导下经皮穿刺瘘静脉或桡动脉置入球囊,通过球囊导管在血栓内局部注射尿激酶进行溶栓,之后再行PTA治疗,统计手术成功率,随访患者术后24个月内瘘通畅率。结果共46例AVF血栓患者成功实施尿激酶局部溶栓联合PTA治疗,1例患者因导丝未通过血栓而改为开放手术,该手术操作的临床成功率为97.9%。46例成功开通的患者术后1、6、12、24个月初级通畅率分别为95.6%、84.8%、81.6%和69.7%;术后1、6、12、24个月次级通畅率分别为97.8%、93.5%、94.7%和93.9%。结论超声引导下尿激酶局部溶栓联合PTA是治疗AVF血栓形成的安全、有效的方法,是维持AVF长期通畅的有效手段。

Objective To evaluate the safety and efficacy of the ultrasound-guided local thrombolysis combined with percutaneous transluminal angioplasty(PTA)for the treatment of autogenous arteriovenous fistula(AVF)thrombosis.Methods A total of 47 patients with AVF thrombosis treated in this hospital from September 2018 to March 2021 were included.The ultrasound-guided percutaneous puncture of the fistula vein or radial artery was used to place a balloon,and the local injection of urokinase into the thrombus through balloon catheter was used to perform the thrombolysis,followed by the PTA treatment.The success rate of the operation and the patency rate of fistula in 24 months followed up after operation were calculated.Results A total of 46 patients with AVF thrombosis were successfully treated with urokinase local thrombolytic therapy combined with PTA.One patient was changed to the open operation because of the guide wire failed to pass through the thrombus.The clinical success rate of this operation was 97.9%.The primary patency rates of 46 patients with successful operation were 95.6%,84.8%,81.6%and 69.7%at 1,6,12 and 24 months after operation,respectively.The secondary patency rates at 1,6,12 and 24 months were 97.8%,93.5%,94.7%and 93.9%,respectively.Conclusion Ultrasound-guided local thrombolysis combined with PTA is a safe and effective therapeutic option for AVF thrombosis,which would maintain the long-term patency of AVF.