中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (07): 494-497.doi: 10.3969/j.issn.1671-4091.2017.07.015

• 血管通路 • 上一篇    下一篇

人工血管内瘘血栓形成的处理

马博1,李金勇1,樊雪强1,叶志东1,陈洁1,郑夏1,杨煜光1, 甄雅楠1,刘鹏1   

  1. 1. 中日友好医院心脏血管外科
  • 收稿日期:2017-01-09 修回日期:2017-05-07 出版日期:2017-07-12 发布日期:2017-07-14
  • 通讯作者: 刘鹏 liupeng5417@163.com E-mail:liupeng5417@163.com

Treatment of thrombosis in arteriovenous graft for hemodialysis

  • Received:2017-01-09 Revised:2017-05-07 Online:2017-07-12 Published:2017-07-14

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摘要： 目的血栓形成是导致人工血管内瘘失功的主要因素，本文主要目的是评估人工血管内瘘血栓形成后取栓治疗的远期效果，总结人工血管内瘘血栓形成的处理经验。方法回顾性分析2009 年8月～2016 年11 月因人工血管内瘘血栓形成在中日友好医院心脏血管外科行手术治疗的51 例患者，总结其相关临床资料，分析取栓治疗后的初级通畅情况及次级通畅情况，利用Cox 模型分析其相关危险因素。结果本研究的平均随访时间是为32.3 个月，取栓治疗后的1 年初级通畅率为54.9%，1 年次级通畅率为94.1%，2 年初级通畅率为36.1%，2 年次级通畅率为72.2%。关于初级通畅情况的多因素分析中，第一次取栓治疗时行球囊扩张治疗为保护性因素(HR=0.361，95% CI 0.135～0.968，P=0.043)。关于次级通畅情况的多因素分析中，男性为危险因素(HR=3.008，95% CI 1.010～9.032，P =0.049)。结论 取栓及相应的介入治疗是人工血管内瘘血栓形成的有效处理手段，具有良好的长期通畅率。

关键词: 人工血管内瘘, 血栓形成, 取栓治疗, 介入治疗

Abstract: Objective Thrombosis is the main cause of arteriovenous graft (AVG) dysfunction. This research evaluated the long-term results of thrombectomy for AVG thrombosis and summarized the treatment experience. Methods This study retrospectively analyzed 51 patients who received thrombectomy and interventions for AVG thrombosis in our center from Aug. 2009 to Nov. 2016. The primary patency and second patency were analyzed. Cox regression was used to evaluate the risk factors for primary patency and second patency. Results The mean time of follow-up was 32.3 months. The primary patency rates were 54.9% and 36.1% after the treatment for one and two years respectively. The secondary patency rates were 94.1% and 72.2% after the treatment for one and two years respectively. Multivariate Cox regression demonstrated that balloon angioplasty in the first thrombectomy operation was the protective factor for primary patency (HR=0.361, 95% CI 0.135～0.968, P=0.043), and male gender was the risk factor for secondary patency (HR=3.008, 95% CI 1.010～9.032, P=0.049). Conclusion Thrombectomy and interventions were the effective treatment for AVG thrombosis. The long-term patency after thrombectomy was acceptable.

Key words: Arteriovenous graft, Thrombosis, Thrombectomy, Intervention