Interventional treatment of acute thrombo-embolism of artificial arteriovenous fistula
10.3969/j.issn.1008-794X.2018.01.015
- VernacularTitle:急性人工动静脉内瘘血栓栓塞介入治疗
- Author:
Yadong SHI
1
;
Jianping GU
;
Liang CHEN
;
Wanyin SHI
;
Xu HE
;
Wensheng LOU
;
Guoping CHEN
;
Haobo SU
;
Tao WANG
Author Information
1. 210006,南京医科大学附属南京医院(南京市第一医院)介入科
- Keywords:
artificial arteriovenous fistula;
thrombosis;
catheter-directed thrombosis;
percutaneous transluminal angioplasty
- From:
Journal of Interventional Radiology
2018;27(1):63-67
- CountryChina
- Language:Chinese
-
Abstract:
Objective To assess the safety and efficacy of catheter-directed thrombolysis combined with percutaneous transluminal angioplasty (PTA) in treating acute thrombo-embolism of artificial arteriovenous fistula.Methods The clinical data of 64 patients with acute thrombo-embolism of artificial arteriovenous fistula (84 events in total),who were admitted to single medical center during the period from January 2012 to September 2016,were retrospectively analyzed.The diagnosis of acute thrombo-embolism of artificial arteriovenous fistula was confirmed by angiography via femoral approach in all patients.Mechanical thrombectomy of the thrombotic occlusion segment by using common guide wire was carried out first,which was followed by bolus injection of urokinase (125,000-375,000 units);if the thrombus was not completely dissolved the catheter would be retained and the urokinase would be continuously infused with a micro-pump until the thrombus was completely dissolved.Conventional balloon dilatation would be employed when the stenosis of artificial arteriovenous fistula lumen was ＞50％ or the stenosis impeded the performance of dialysis.Kaplan-Meier survival curve was used to estimate the primary and secondary cumulative patency rates after the first intervention.Results Of the 84 interventional procedures,technical success was achieved in 69 procedures (82.1％).A total of 14 conventional balloon dilatation procedures had to be conducted as the fistula was seriously narrowed,and up to 12 procedures (85.7％) were succeeded.The overall clinical success rate was 78.5％ (66/84).During the therapeutic course,bleeding event occurred in 7 procedures (8.3％),including major bleeding (n=3) and minor bleeding (n=4).After the treatment,the 3-,6-,12-,24-month primary and secondary patency rates were 76.1％,63.6％,40.8％,12.5％ and 81.3％,70.8％,47.0％,32.5％respectively.Conclusion For the treatment of acute thrombo-embolism of artificial arteriovenous fistula,catheter-directed thrombolysis is safe and effective,it can assist conventional balloon dilatation therapy to obtain satisfactory therapeutic result for internal fistula stenosis.
