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Vol. 53. Núm. 6.
Páginas 393-403 (Enero 2001)
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Vol. 53. Núm. 6.
Páginas 393-403 (Enero 2001)
Acceso a texto completo
Tratamiento de la trombosis de los injertos de PTFE para hemodiálisis mediante trombectomía percutánea. Estudio prospectivo
Treatment of PTFE haemodialysis graft thrombosis by percutaneous thrombectomy. a prospective study
Tratamento da trombose dos enxertos de PTFE para hemodi´lise através de trombectomia percutânea. estudo prospectivo
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J.I. Blanes-Mompóa,1
Autor para correspondencia
lochv@arrakis.es

Servicio de Angiología y Cirugía Vascular. Hospital Universitario Dr. Peset. Avda. Gaspar Aguilar, 90. E-46017 Valencia.
, J. Martínez-Rodrigob, J.L. Górriz-Teruelc, I. Crespo-Morenoa, F. Gómez-Palonésa, S. Martínez-Meléndeza, I. Martínez-Perellóa, E. Ortiz-Monzóna, J. Palmero-Da Cruzc, E. Lonjedo-Vicentb
a Servicio de Angiología y Cirugía Vascular y Endovascular.
b Servicio de Radiología.
c Servicio deNefrología. Hospital Universitario Dr. Peset. Valencia,España.
Información del artículo
Summary

Objective. Nowadays, the guidelines (DOQI) recommend a three months patency rate of 40% for percutaneous thrombectomy of thrombosed dialysis AV grafts. Our study purpose is to evaluate the efficacy of mechanical thrombectomy for treatment of this dialysis AV grafts complication. Patients and methods. 107 percutaneous thrombectomies of PTFE thrombosed dialysis AV grafts performed in 75 patients were prospectively analyzed, using hydrodynamic technique (Hydrolyser®) in the 35 first cases (33%) and simple mechanical technique with an angioplasty balloon in the last 72 ones (67%). Underlying lesions were evaluated with fistulography and angioplasty was done when required. Anatomic success, clinical success, underlying lesions, initial thrombosis (72 hours), patency and complications were analyzed. Results. Anatomic success was obtained in 103 cases (96.2%) and clinical success in 101 cases (94.4%). The initial thrombosis rate was 17.3%. Underlying stenosis were detected in 68 grafts (90.6%), and were successfully treated with PTA. Primary patency was 50%, 39% and 30% and secondary patency was 62%, 49% and 40% at 3, 6 and 12 months. Major complications occurred in 2 cases (1.86%). Time elapsed after the thrombotic episode (1.6 days) (p=0.01) and the hydrodinamic technique (p=0.0026) result in a lower patency rate. Conclusions. Mechanical thrombectomy is safe and effective for the treatment of the thrombosed PTFE hemodialysis AV graft. The DOQI recommendations for treatment of this graft complication are fulfilled with this technique.

key words:
Angioplasty
Arteriovenous fistula
Dialysis vascular access
Percutaneous thrombectomy
PTFE graft
Resumen

Objetivos. Lasguíasactuales (DOQI) recomiendan una permeabilidad primaria a los tres meses del 40% en el tratamiento percutáneo de las trombosis de las prótesis de PTFE para hemodiálisis. El objetivo de nuestro estudio es valorar prospectivamente la eficacia de la trombectomía mecánica en el tratamiento de esta complicación de las prótesis para hemodiálisis. Pacientes y métodos. Hemos analizado prospectivamente 107 trombectomías percutáneas consecutivas de prótesis de PTFE para hemodiálisis realizadas en 75 pacientes con técnica hidrodinámica (Hydrolyser®) en los primeros 35 casos (33%) y con técnica mecánica simple utilizando un balón de angioplastia en los últimos 72 casos (67%). Las lesiones subyacentes se diagnosticaron mediante fistulografía, tratándose mediante angioplastia cuando era necesario. Se analizó el éxito anatómico, el éxito clínico, las lesiones subyacentes, las trombosis precoces (72 horas), lapermeabilidady las complicaciones. Resultados. El éxito anatómico se ha conseguido en 103 casos (96,2%) y el clínico en 101 (94,4%). La tasa de trombosis precoz ha sido del 17,3%. En 68 casos (90,6%) se han detectado estenosis asociadas, que han sido tratadas con ATP. A los 3, 6 y 12 meses, la permeabilidad primaria ha sido del 50, 39 y 30%, y la secundaria de 62, 49 y 40%. Se han producido dos complicaciones mayores (1,86%). Conclusiones. La trombectomía mecánica es seguray eficaz en el tratamiento de las trombosis de las prótesis de PTFE para hemodiálisis. Las recomendaciones del DOQI se cumplen completamente con esta técnica.

Palabras clave:
Acceso vascular para hemodiálisis
Angioplastia
Fístula arteriovenosa
Prótesis PTFE
Trombectomíapercutánea
Resumo

Objectivos. As directrizes actuais (DOQI) recomendam uma permeabilidade primária de 40% aos três meses no tratamento percutâneo das tromboses das próteses de PTFE para hemodiálise. O objectivo do nosso estudo é avaliar prospectivamente a eficácia da trombectomia mecânica no tratamento desta complicação das próteses para hemodiálise. Doentes e métodos. Analisámos prospectivamente 107 trombectomias percutâneas consecutivas de próteses de PTFE para hemodiálise, realizadas em 75 doentes por técnica hemodinâmica (Hydrolyser®) nos primeiros 35 casos (33%) e por técnica mecânica simples utilizando um balão de angioplastia nos últimos 72 casos (67%). As lesões subjacentes foram diagnosticadas através de fistulografia, sendo tratada com angioplastia quando necessário. Analisou-se o êxito anatómico, o êxito clínico, as lesões subjacentes, as tromboses precoces (72 horas) a permeabilidade e as complicações. Resultados. O êxito anatómico foi alcançado em 103 casos (96,2%), o clínico em 101 (94,4%). O índice de trombose precoce foi de 17,3%. Em 68 casos (90,6%) foram detectadas estenoses associadas, que foram tratadas com ATP. Aos 3, 6 e 12 meses, a permeabilidade primária foi de 50, 39 e 30%, e a secundária de 62, 49 e 40%. Verificaram-se duas complicações mais graves (1,86%). Conclusões. A trombectomia mecânica é segura e eficaz no tratamento das tromboses das próteses de PTFE para hemodiálise. As recomendações do DOQI são completamente cumpridas com esta técnica.

Palavras chave:
Acesso vascular para hemodiálise
Angioplastia
Fístula arteriovenosa
Prótese PTFE
Trombectomia percutânea
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Copyright © 2001. SEACV
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