关键词: 动静脉内瘘, 血栓闭塞, 尿激酶, 球囊扩张术

Abstract: Objective  To analyze the clinical effect and related influencing factors of urokinase thrombolysis combined with balloon dilation for the treatment of arteriovenous fistula (AVF) occlusion due to thromboembolism.  Method   The patients with AVF occlusion due to thromboembolism treated in The First Hospital of Nanchang City were retrospectively analyzed. The success rate of the operation and the incidence of complications were collected. Factors that possibly influence the success rate including diabetes, utilized period of the AVF, length of the occlusion in AVF, occlusion time, hemoglobin level and anatomical factors of the AVF were statistically analyzed.  Results   A total of 84 cases were enrolled in this study, of which 69 cases had successful patency of the AVF after the operation with the total success rate of 82.1%. The overall complication rate was 7.1%, and no serious complications occurred. Univariate analysis showed that the success rate of the operation was not related to gender (χ2=0.202, P=0.653), diabetes (χ2=0.387, P=0.534), location of AVF (χ2=0.082, P=0.774), establishment time (χ2=2.889, P=0.089), length of thrombus (χ2=1.445, P=0.229), occlusion period (χ2=0.082, P=0.774) and hemoglobin level (χ2=0.365, P=0.546), but closely related to anatomical factors of the AVF (χ2=29.238, P<0.001). The success rate of the operation was significantly different between the patients with 2 venous outflows (χ2=18.287, P<0.001) or 3 venous outflows (χ2=24.199, P<0.001) and those with one venous outflow, but had no difference between the patients with 2 or 3 venous outflows (χ2=0.002, P=0.967). Multivariate analysis showed that the number of venous outflow of the AVF was an independent risk factor affecting the success rate of the operation (OR=8.296, 95% CI: 2.724~25.267, P<0.001), and the establishment time of fistula was a protective factor affecting the success rate of the operation (OR=0.976, 95% CI: 0.959~0.993, P=0.006).  Conclusions  Urokinase thrombolysis combined with balloon dilation is safe and effective for the treatment of thromboembolism in occluded AVF. The number of venous outflow of the AVF is an independent risk factor, and the establishment time of fistula is a protective factor to affect the success rate of the operation; gender, diabetes, the location of fistula, the length of thrombus, the occlusion period, and the hemoglobin level have no influences on the success rate of the operation.

Key words: Arteriovenous fistula, Thromboembolism, Urokinase, Balloon dilatation