Duplex Ultrasound-Guided Manual Declotting with Adjuvant Angioplasty for Restoration of Function in Thrombosed Native Dialysis Fistulae

彩色杜卜勒超音波導引下實行人工去栓輔以氣球擴張術以回複血栓形成之自體血液透析瘻管之功能

黃玄禮(Hsuan-Li Huang) ； 溫明賢(Ming-Shien Wen) ； 簡竹君(Chu-Chun Chien) ； 方基存(Ji-Tseng Fang) ； 黃秋錦(Chiu-Ching Huang) ； 吳德朗(De-Lon Wu)

《Acta Nephrologica》 14卷4期 (2000/10) Pp. 316-316

並列摘要

PUROSE: To evaluate the efficacy, safety and feasibility of Duplex ultrasound-guided manual declotting with adjuvant angioplasty in treatment of thrombosed native dialysis fistulae.
MATERIALS AND METHODS: Form May 2000 to July 2001, 9 pts with thrombosis of native dialysis fistula, of which the thrombosis in the vessel was less than 10 cm and smaller than 10 mm., underwent the manual declotting and angioplasty in this institution. There were 5 women and 4 men with a mean age of 54.3 years (26-68 years). The thrombus occurred within 24 hours in 4 pts and between 24 and 72 hours in 5 pts before the procedure. Manual declotting of the thrombus was performed under the monitoring of Duplex scan, followed by angioplasty. Patients were followed by Duplex scan at 2 weeks, 1 month, 3 months and then every 3 months or evidence of clinical dysfunction of fistula.
RESULTS: Nine native dialysis fistulae (6 at wrist and 3 at elbow) undergoing the procedure had 100% procedure success rate without complications. Two to five manipulations were required to declot thrombus. Mean thrombus length was 5.4cm (range 3.9~7.2 cm) and the stenotic lesion length was 3.4cm (range 0.7~5.9 cm). Diameter of stenosis after declotting by Duplex scan was 74 ± 9% and adjuvant angioplasty reduced the stenosis from 83 ± 14% to 28 ± 8%. The total procedure time was less than 30 minutes. During the maximal follow-up of 15 months, two fistulae suffered from recurrent thrombosis. One was abandoned and the other successfully restored the function by repeat procedures. Three fistulae developed restenosis without thrombus requiring repeat angioplasty. The remaining 4 fistulae remained patent. The meian survival time of primary patency, assisted primary patency and secondary patency was 5.4±4.4,7.5±5.2,8.5±4.6months, respectively.
CONCLUSIONS: Duplex ultrasound-guided manual declotting with adjuvant angioplasty is a safe procedure and can be performed easily in selective patients. It reduces the fluoroscopy time significantly and prolongs the lifespan of native dialysis fistulae.