A Novel Intragraft Pressure-Guided Technique versus Angiography-Guided Technique in Salvage of Thrombosed Hemodialysis Graft: A Randomized Controlled Trial

作者：Lai, Chi Cheng; Mar, Guang Yuan; Fang, Hua Cheng; Tsai, Han Lin; Tseng, Ching Jiunn; Chiou, Chuen Wang; Lin, Shoa Lin; Liu, Chun Peng^*

来源：Acta Cardiologica Sinica, 2012, 28(4): 324-331.

• Angiography
• Arteriovenous graft
• Intragraft pressure
• Patency
• Thrombectomy

Purpose: To evaluate the role of an intragraft pressure-guided technique (IGT) for salvaging thrombosed arteriovenous grafts (AVGs).
Methods: Ninety hemodialysis patients with acutely thrombosed AVGs were randomized into two groups: 1) the intragraft pressure-guided technique (IGT) group, and 2) the angiography-guided technique (AGT) group. In IGT, treatment sites were identified by a balloon pullback method, and then selected according to intragraft pressure (IGP) obtained after effective thrombectomy. Whenever possible, IGP was stabilized at 50-100 mmHg by performing outflow and inflow treatments, in case IGP was greater than 100 mmHg and IGP smaller than 50 mmHg, respectively. All AGT treatments were guided by angiography, and technical success was determined by angiography as well. To further ensure the integrity of this study, operating physicians were blinded to technical endpoints.
Results: Comparisons of IGT and AGT showed that IGT required significantly fewer angiograms (4.7 +/- 1.9 versus 13.1 +/- 3.6; p < 0.0001), fewer total angiographic frames (378.0 +/- 168.5 versus 1504.6 +/- 407.1; p < 0.0001), and shorter procedure time (60.1 +/- 20.5 versus 106.3 +/- 30.1 minutes; p < 0.0001) with a low complication rate (4.4%) and a high success rate (93.3%). Final IGP is useful in predicting 3-month patency (AUC = 0.77). Patients with final IGP below 80 mmHg compared to those with IGP above 80 mmHg had a significantly higher cumulative incidence of patency at 3 months (72.7% versus 39.1%; p = 0.007 by log-rank test).
Conclusion: The IGT is a safe and effective technique that may reduce the need for angiography and shorten the procedure time necessary to salvage AVGs. Final IGP may predict the post-salvage 3-month patency.

• 出版日期2012-12
• 单位中山大学