摘要
目的 探讨超声引导下血管腔内治疗对自体动静脉内瘘(autogenous arteriovenous fistula,AVF)血栓形成的有效性和安全性.方法 该研究为单中心回顾性队列研究,回顾性分析2018年8月至2021年6月在河北医科大学第一医院因AVF血栓形成行超声引导下血管腔内治疗患者的资料,根据所采用的手术方式不同分为2组,其中行经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)+钻孔取栓术治疗的患者为A组,单纯PTA治疗的患者为B组.随访1年,对比2组手术技术成功率、初级通畅率、次级通畅率及并发症情况.结果 共入组152例,其中A组74例,B组78例.2组患者性别、年龄、糖尿病及高血压人数占比、AVF血栓形成时间差异均无统计学意义(均P＞0.05);相比B组,A组血栓段直径及长度更大[13.0(9.0,16.0)mm 比6.0(5.0,6.5)mm,Z=-9.362,P＜0.001;12(8,15)cm比3(3,4)cm,Z=-10.061,P＜0.001],AVF建立时间更长[5(2,7)年比2(1,5)年,Z=-2.698,P=0.007].总体手术成功率为 96.7％(147/152),其中 A 组 95.9％(71/74),B 组 97.4％(76/78),2组间差异无统计学意义(x2=0.004,P=0.952).Kaplan-Meier生存分析结果显示,总体AVF血栓形成人群术后3、6、12个月的初级通畅率分别为87.1％、71.4％和56.6％,次级通畅率分别为97.1％、96.4％和94.1％.A组3、6、12个月的初级通畅率分别为82.4％、66.7％和53.6％,次级通畅率分别为95.7％、94.2％和89.7％,B组3、6、12个月的初级通畅率分别为91.5％、73.2％和59.7％,次级通畅率分别为98.6％、98.6％和98.5％.A组与B组术后初级及次级通畅率在3、6、12个月时间点的差异均无统计学意义(均 P＞0.05).A组手术时长长于 B组[2.0(1.9,2.0)h 比 2.0(1.0,2.0)h,Z=-5.181,P＜0.001],但2组均未发生严重并发症.结论 两种手术方式在AVF血栓治疗中疗效确切,安全可靠,有较高的临床应用价值.
Abstract
Objective To investigate the effectiveness and safety of ultrasound-guided endovascular therapy for autogenous arteriovenous fistula(AVF)thrombosis.Methods It was a single-center retrospective cohort study.Data of patients undergoing ultrasound-guided intravascular therapy due to AVF thrombosis in the First Hospital of Hebei Medical University from August 2018 to June 2021 were analyzed.According to different surgical procedures,the patients were divided into two groups.Patients treated with percutaneous transluminal angioplasty(PTA)+drilling thrombectomy were in group A,and patients treated with PTA only were in group B.After 1 year of follow-up,the surgical technique success rate,primary patency rate,secondary patency rate and complications were compared between the two groups.Results A total of 152 patients were enrolled,including 74 in group A and 78 in group B.There were no significant differences in gender,age,proportion of patients with diabetes and hypertension,and thrombosis time of AVF between the two groups(all P＞0.05).Compared with group B,the diameter and length of thrombus in group A were larger[13.0(9.0,16.0)mm vs.6.0(5.0,6.5)mm,Z=-9.362,P＜0.001;12(8,15)cm vs.3(3,4)cm,Z=-10.061,P＜0.001],and the establishment time of AVF was longer[5(2,7)years vs.2(1,5)years,Z=-2.698,P=0.007].Among the overall patients,the success rate of surgery was 96.7％(147/152),and the success rate of surgery was 95.9％(71/74)in group A and 97.4％(76/78)in group B respectively,with no statistical difference(x2=0.004,P=0.952).Kaplan-Meier survival analysis showed that,overall,the primary patency rate at 3rd,6th and 12th month after operation was 87.1％,71.4％and 56.6％,and the secondary patency rate was 97.1％,96.4％and 94.1％,respectively.The primary patency rate of group A at 3rd,6th and 12th month was 82.4％,66.7％and 53.6％,and the secondary patency rate was 95.7％,94.2％and 89.7％,respectively.The primary patency rate of group B at 3rd,6th and 12th month was 91.5％,73.2％and 59.7％,and the secondary patency rate was 98.6％,98.6％and 98.5％,respectively.There was no significant difference in the primary and secondary patency rate between group A and group B at 3rd,6th and 12th month(all P＞0.05).The duration of operation in group A was longer than that in group B[2.0(1.9,2.0)h vs.2.0(1.0,2.0)h,Z=-5.181,P＜0.001],but no serious complications occurred in both groups.Conclusion The two surgical methods are effective,safe and reliable in the treatment of AVF thrombosis,and have high clinical application value.
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