TITLE: Outcomes of Catheter-Directed Thrombolysis for Arteriovenous Fistula Thrombosis in Singapore: Is It Still Relevant Today?
Objective: To review the outcomes of catheter-directed thrombolysis (CDT) for salvage of thrombosed arteriovenous fistula (AVF) in a single centre in Southeast Asia.
Methods: A retrospective study of CDT in AVF between January 2015 and July 2018 at a tertiary university hospital was carried out.
Results: Within the study period, 85 patients underwent CDT for AVF thrombosis. Of these patients, 78% underwent CDT for 24 h and 12% required CDT for 48 h. Moreover, 14% of patients had bleeding during CDT and hence required a decrease in dosing or complete cessation. Incidence of intracranial haemorrhage was 1%, and technical success was 92%. Post CDT, primary patency rates at 12, 24 and 36 months were 87%, 62% and 36%, respectively; assisted primary patency rates at 12, 24 and 36 months were 96%, 82% and 69%, respectively; and secondary patency rates at 12, 24 and 36 months were 99%, 93% and 86%, respectively. Multivariate analysis did not identify any predictive factors for patency post CDT.
Conclusion: Within our study population, CDT for AVF salvage conferred good technical results with low rates of complications. There was good primary patency at 12 months, and the results were sustained up to 36 months. It remains a useful modality for fistula salvage, avoiding surgical intervention.
SOURCE: Yeo CB, Yong E, Hong Q, et al. Outcomes of Catheter-Directed Thrombolysis for Arteriovenous Fistula Thrombosis in Singapore: Is It Still Relevant Today?[J]. Ann Vasc Dis, 2021, 14(1):5-10. DOI: 10.3400/avd.oa.20-00112.
目的：在东南亚的一个中心，回顾导管溶栓术（CDT）挽救血栓性动静脉内瘘（AVF）的结果。
方法：回顾性研究2015年1月至2018年7月在一家三级大学医院进行的AVF中CDT的研究。
结果：在研究期内，有85例因AVF血栓形成而接受CDT治疗。在这些患者中，有78％进行了CDT 24小时，而12％的患者需要CDT 48小时。此外，有14％的患者在CDT期间出血，因此需要减少剂量或完全停用。颅内出血的发生率为1％，技术成功率为92％。 CDT后，在12、24和36个月时的一期通畅率分别为87％，62％和36％；在12、24和36个月时辅助初级通畅率分别为96％，82％和69％。在12、24和36个月时的二期通畅率分别为99％，93％和86％。多变量分析未发现CDT后通畅的任何预测因素。
结论：在我们的研究人群中，用于AVF抢救的CDT带来了良好的技术效果，并发症发生率低。 12个月时一期通畅良好，效果持续长达36个月。它仍然是挽救瘘管的有用方式，避免了手术干预。
启发：导管溶栓有风险，早期干预有助于挽救内瘘。本研究的一期通畅率偏高，而这类患者往往存在内瘘结构异常，比如狭窄，往往需要进行腔内治疗或重造。
