ABSTRACT
Objective To assess the safety and efficacy of catheter-directed thrombolysis combined with percutaneous transluminal angioplasty (PTA) in treating acute thrombo-embolism of artificial arteriovenous fistula.Methods The clinical data of 64 patients with acute thrombo-embolism of artificial arteriovenous fistula (84 events in total),who were admitted to single medical center during the period from January 2012 to September 2016,were retrospectively analyzed.The diagnosis of acute thrombo-embolism of artificial arteriovenous fistula was confirmed by angiography via femoral approach in all patients.Mechanical thrombectomy of the thrombotic occlusion segment by using common guide wire was carried out first,which was followed by bolus injection of urokinase (125,000-375,000 units);if the thrombus was not completely dissolved the catheter would be retained and the urokinase would be continuously infused with a micro-pump until the thrombus was completely dissolved.Conventional balloon dilatation would be employed when the stenosis of artificial arteriovenous fistula lumen was ＞50％ or the stenosis impeded the performance of dialysis.Kaplan-Meier survival curve was used to estimate the primary and secondary cumulative patency rates after the first intervention.Results Of the 84 interventional procedures,technical success was achieved in 69 procedures (82.1％).A total of 14 conventional balloon dilatation procedures had to be conducted as the fistula was seriously narrowed,and up to 12 procedures (85.7％) were succeeded.The overall clinical success rate was 78.5％ (66/84).During the therapeutic course,bleeding event occurred in 7 procedures (8.3％),including major bleeding (n=3) and minor bleeding (n=4).After the treatment,the 3-,6-,12-,24-month primary and secondary patency rates were 76.1％,63.6％,40.8％,12.5％ and 81.3％,70.8％,47.0％,32.5％respectively.Conclusion For the treatment of acute thrombo-embolism of artificial arteriovenous fistula,catheter-directed thrombolysis is safe and effective,it can assist conventional balloon dilatation therapy to obtain satisfactory therapeutic result for internal fistula stenosis.
ABSTRACT
Objective To compare the safety and clinical efficacy of recombinant human tissue plasminogen activator (rt-PA) and urokinase(UK)in catheter-directed thrombolysis(CDT)for the treatment of subacute iliofemoral deep venous thrombosis(DVT). Methods From June 2013 to June 2017, a total of 116 subacute DVT patients underwent consistent CDT with either rt-PA or urokinase, or simple anticoagulation treatment in this study.The patients were divided into three groups for comparison:rt-PA-CDT group(n=43), UK-CDT group(n=39)and anticoagulation group(n=34). The baseline data, thrombolysis duration, rt-PA or UK dosages, thrombolytic rate and clinical efficacy rate were compared among the three groups. Independent t-test(accorded to normal distribution)was used to analyze the thrombolysis duration.The quantitative data were analyzed with analysis of varianc and the qualitative data were compared by the chi-square test. Results There was no significant difference in general clinical features among the three groups(P>0.05). The thrombolysis duration, total dosages and thrombolytic rate (≥50)were(5.8±1.3)d,(49.7±16.1)mg,86.0% for rt-PA-CDT group,and(6.3±1.5)d,(440±99)×104 U, 66.7% for UK-CDT group.The difference of thrombolysis duration was not statistically significant between the rt-PA-CDT group and UK-CDT group(t=-1.868, P>0.05). The thrombolysis rate of rt-PA-CDT group was significantly higher than that of UK-CDT group(χ2=4.315, P<0.05). The time of obtaining grade Ⅲthrombosis rate was shorter for rt-PA-CDT group(4.7±0.9)d compared with UK-CDT group(6.0±1.2 d) (t=-2.343,P<0.05).The clinical efficacy rates of the rt-PA-CDT group[88.4%(38/43)]and UK-CDT group [76.9%(30/39)]were significantly higher than that of anticoagulation group[26.5%(9/34)](P<0.05).There was no statistical difference between the rt-PA-CDT group and UK-CDT group(χ2=1.893, P>0.05). No severe complications were found in all groups. The incidence rates of mild complication of the rt-PA-CDT group, UK-CDT group and anticoagulation group were 16.3%(7/43), 17.9%(7/39)and 8.8%(3/34), respectively, and there were no significant differences among the three groups(χ2=1.396, P>0.05). Conclusion The clinical efficacy of CDT using rt-PA and UK for subacute DVT is better than simple anticoagulation treatment.Thrombolytic rate of rt-PA is superior to UK.