Predictors of arteriovenous graft patency after radiologic intervention in hemodialysis patients
Predictors of arteriovenous graft patency after radiologic intervention in hemodialysis patients
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DOI：
10.1016/s0272-6386(05)80010-1
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发表时间：
2001-05-01
影响因子：
13.2
通讯作者：
Allon, M
中科院分区：
文献类型：
--
作者：
Lilly, RZ;Carlton, D;Allon, M
血液透析患者的动静脉移植物易于复发性狭窄和血栓形成，需要频繁的放射学和外科干预以优化其长期通畅性。关于放射学干预后决定移植物结果的因素知之甚少。本研究探讨了择期血管成形术或血栓切除术后无介入移植物存活的临床和影像学预测因素。前瞻性计算机数据库用于确定1996年4月1日至1999年6月30日在伯明翰的亚拉巴马大学进行的所有移植血管成形术（n = 330）和血栓切除术（n = 326）的结局。血管成形术和血栓切除术后1个月时的原发性移植物存活率分别为86%和43%，3个月时分别为71%和30%，6个月时分别为51%和19%，12个月时分别为28%和8%。血管成形术后的中位无干预移植物存活时间明显长于血栓切除术后（6.7个月对0.6个月; P < 0.001）。即使对于无残余狭窄的手术子集，也观察到血管成形术优于血栓切除术的上级结局（中位生存期，6.9个月vs 2.5个月; P < 0.001）。对于择期血管成形术和血栓切除术，中位移植物生存期与残余狭窄程度呈负相关。血管成形术后中位无介入移植物存活率与血管成形术后移植物内与全身收缩压比值呈负相关（比值0.6时分别为7.6、6.9和5.6个月; P < 0.001）。血管成形术或血栓切除术后的无干预移植物存活率不受移植物位置（前臂与上臂）、狭窄部位数量或糖尿病的影响。总之，选择性血管成形术后移植物存活时间明显长于血栓切除术，即使术后影像学表现表明狭窄病变完全消退。此外，需要后续移植物干预的风险可以通过两个简单的放射学测量来预测：狭窄程度和移植物内与全身收缩压的比值。这些参数可以帮助确定监测给定移植物中复发性狭窄的频率。(C)2001年由国家肾脏基金会，公司。
Arteriovenous grafts in hemodialysis patients are prone to recurrent stenosis and thrombosis, requiring frequent radiologic and surgical interventions to optimize their long-term patency. Little is known about the factors that determine graft outcome after a radiologic intervention. The present study examined the clinical and radiologic predictors of intervention-free graft survival after elective angioplasty or thrombectomy. A prospective computerized database was used to determine the outcomes subsequent to all graft angioplasties (n = 330) and thrombectomies (n = 326) performed at the University of Alabama at Birmingham between April 1, 1996, and June 30, 1999. Primary graft survival rates after angioplasty and thrombectomy were 86% versus 43% at 1 month, 71% versus 30% at 3 months, 51% versus 19% at 6 months, and 28% versus 8% at 12 months, respectively. The median intervention-free graft survival time was substantially longer after angioplasty than thrombectomy (6.7 versus 0.6 months; P < 0.001). The superior outcome of angioplasty over thrombectomy was observed even for the subset of procedures with no residual stenosis (median survival, 6.9 versus 2.5 months; P < 0.001), The median graft survival was inversely related to the magnitude of residual stenosis for both elective angioplasty and thrombectomy. Median intervention-free graft survival after angioplasty was inversely related to the postangioplasty intragraft to systemic systolic pressure ratio (7.6, 6.9, and 5.6 months for ratios 0.6, respectively; P < 0.001). Intervention-free graft survival after angioplasty or thrombectomy was not affected by graft location (forearm versus upper arm), number of stenotic sites, or presence of diabetes. In conclusion, graft survival is substantially longer after elective angioplasty than thrombectomy, even when the radiologic appearance after the procedure suggests complete resolution of the stenotic lesion. Moreover, the risk for requiring a subsequent graft intervention can be predicted from two simple radiologic measurements: grade of stenosis and intragraft to systemic systolic blood pressure ratio. These parameters may help determine the frequency of monitoring for recurrent stenosis in a given graft. (C) 2001 by the National Kidney Foundation, Inc.