Detection and treatment of dysfunctional hemodialysis access grafts: Effect of a surveillance program on graft patency and the incidence of thrombosis
Detection and treatment of dysfunctional hemodialysis access grafts: Effect of a surveillance program on graft patency and the incidence of thrombosis
复制标题
DOI：
10.1148/radiology.199.3.8637982
复制
发表时间：
1996-06-01
期刊：
影响因子：
19.7
通讯作者：
Oglevie, SB
中科院分区：
文献类型：
--
作者：
Safa, AA;Valji, K;Oglevie, SB
目的：通过早期发现和经皮腔内血管成形术（PTA）治疗移植物相关狭窄，确定血液透析移植物监测方案在降低移植物血栓发生率和延长移植物通畅方面的价值。材料与方法：在41年半的时间里，通过常规移植物检查和几个透析参数的测量，确定了57例患者（56男1女，年龄27-76岁）106例疑似移植物功能障碍。血管造影发现的移植物相关狭窄用PTA治疗。结果：体格检查异常是移植物功能障碍最常见的唯一指征。在106例进行血管造影评估的病例中，97例（92%）至少有一种病变。90例治疗病例中，88例PTA治疗成功。1年时，动静脉瘘（avf）的初次通畅率为16%，聚四氟乙烯（PTFE）移植物的初次通畅率为23%。通过监测和重复PTA早期发现狭窄，avf的1年初级辅助通畅率为67%，PTFE移植为68%。移植物血栓的发生率由1988年的48%下降到1994年的17% （P < 0.001）。结论：血液透析移植物监测方案可显著降低移植物血栓的发生率。虽然PTA后的原发性通畅率较低，但对发现的狭窄重复PTA可获得良好的原发性辅助通畅率。
PURPOSE: To determine the value of a hemodialysis graft surveillance program in reducing the incidence of graft thrombosis and prolonging graft patency by means of early detection and percutaneous transluminal angioplasty (PTA) of graft-related stenoses.MATERIALS AND METHODS: For 41/2 years, routine graft examination and measurement of several dialysis parameters were used to identify 106 cases of suspected graft dysfunction in 57 patients (56 men, one woman; aged 27-76 years). Graft-related stenoses detected with angiography were treated with PTA.RESULTS: Abnormal physical examination findings were the most com mon sole indication of graft dysfunction. Of the 106 cases referred for angiographic evaluation, 97 (92%) had at least one lesion. PTA was successful in 88 of 90 treated cases. The primary patency rates at 1 year were 16% for arteriovenous fistulas (AVFs) and 23% for polytetrafluoroethylene (PTFE) grafts. Early detection of stenoses by means of surveillance and repeated PTA enabled 1-year primary assisted patency rates of 67% for AVFs and 68% for PTFE grafts. The incidence of graft thrombosis fell from 48% in 1988 to 17% in 1994 (P < .001).CONCLUSION: The hemodialysis graft surveillance program resulted in a statistically significant reduction in the incidence of graft thrombosis. Although primary patency rates after PTA were low, repeated PTA of detected stenoses allowed good primary assisted patency rates.