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- Title
动静脉内瘘功能不良行经皮血管腔内 治疗后2 年随访效果评价.
- Authors
罗湘兰; 宋利; 符霞; 全梓林; 赵立艳; 崔冬梅; 彭银燕; 陈诚; 冯仲林; 陶一鸣; 叶智明; 梁馨苓
- Abstract
Objective:To discuss the secondary patency rate at 2⁃year after treatment through percutaneous transluminal angioplasty, surgical thrombectomy, and percutaneous intraluminal urokinase thrombolysis for arteriovenous fistula(AVF). Methods:A retrospective cohort study design was used to collect data of all patients who underwent maintenance hemodialysis at the Blood Purification Center of Guangdong Provincial People's Hospital from January 1, 2016 to June 1, 2017. According to the intervention method, when the patient's AVF first appeared (thrombotic occlusion or vascular stenosis accompanied by insufficient flow of the internal fistula), the patients were divided into 3 groups: simple urokinase thrombolysis group, percutaneous transluminal angioplasty group, and surgical operation suppository group. Observe the secondary patency rate of fistula, the success rate of intervention, and the influencing factors of AVF intervention failure within 2 years after different interventions. Results:Among the 133 patients with internal AVF for the first time(99 cases of thrombotic occlusion, 34 cases of vascular stenosis accompanied by insufficient flow of internal fistula), 112 cases(84. 2%)successed with the intervention. After the 2 ⁃ year intervention, 31 cases(45. 6%)of AVF failure occurred in the urokinase thrombolysis group, 10 cases(25. 6%)of AVF failure occurred in the percutaneous transluminal angioplasty group, and 6 cases(23. 1%)of AVF failure occurred in the surgical thrombectomy group, the difference between the three groups was statistically significant(P=0. 040). The median time of using different methods was 1. 24(0. 50, 2. 00)years in the percutaneous transluminal angioplasty group, 0. 59(0. 32, 0. 96)years in the urokinase thrombolytic group, and 1. 18(0. 63, 2. 00)years in the surgical thrombus removal group;the difference was statistically significant(P=0. 008). Kaplan ⁃ Meier survival analysis(log ⁃ rank test) showed no significant difference in the 2⁃year secondary patency rate of AVF between the 3 groups. After the Cox proportional hazard model was corrected for the use time of the AVF, blood calcium, blood phosphorus, and calcium-phosphorus product, the 2⁃year secondary patency rate of the AVF in the surgical thrombectomy group was higher than that in the urokinase thrombolytic group, HR(95%CI)=0. 31(0. 11, 0. 82), P=0. 02, and percutaneous transluminal angioplasty group, HR(95%CI)=0. 60(0. 26, 1. 38), P=0. 23. Multivariate analysis showed that the use time of internal fistula≥3 years and the product of calcium and phosphorus greater than 66 mg2/dL2 were related to the AVF failure at 2 years after the intervention of internal fistula. Conclusions:Percutaneous transluminal angioplasty and surgical thrombectomy could improve the patency rate of AVF after 2 years. Postoperative calcium and phosphorus management should be strengthened to help improve the intervention effect.
- Subjects
CONFIDENCE intervals; SURGICAL complications; THROMBOLYTIC therapy; RETROSPECTIVE studies; LOGROLLING (Medical procedure); ARTERIOVENOUS fistula; VASCULAR surgery; VEIN surgery; VASCULAR resistance; THROMBECTOMY; DESCRIPTIVE statistics; KAPLAN-Meier estimator; HEMODIALYSIS; UROKINASE; ANGIOPLASTY; PROPORTIONAL hazards models
- Publication
Chinese Nursing Research, 2021, Vol 35, Issue 23, p4144
- ISSN
1009-6493
- Publication type
Article
- DOI
10.12102/j.issn.1009-6493.2021.23.002