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Diyaliz Fistül Trombozlarının Perkütan Tedavisinde Kullanılacak Trombolitik İlaç Dozu Nasıl Belirlenmeli?

Year 2023, , 537 - 542, 30.12.2023
https://doi.org/10.31832/smj.1347210

Abstract

Amaç: Diyaliz fistül trombozlarının perkütan tedavisinde kullanılan standart doz ile tromboze segment uzunluğuna göre ayarlanan doz yaklaşımlarının başarısını karşılaştırmak amaçlandı.
Gereç-Yöntem: Çalışmaya merkezimizde fistül trombozu nedeniyle anjioplasti yapılan 42 hasta dahil edildi. Hastaların 24’ü erkek (%57,1), 18’i kadın (%42,9) hastaydı. 21 hastaya (%50) standart 5 mg dozda, 21 hastaya ise (%50) tromboze segmentin uzunluğuna göre cm’ye 1 mg olacak şekilde değişen dozlarda (ortanca 7 mg, 4-10 mg arası) trombolitik ajan ultrason eşliğinde kontrollü bir şekilde enjekte edildi. Sonrasında uygun boyut ve uzunlukta balon kateterler yardımıyla anjioplasti yapıldı.
Bulgular: İki grup arasında yaş (p=0,633), cinsiyet (p=0,674), tromboze segment uzunluğu (p=0,484), tromboz süresi(p=0,911), primer (p=0,618) ve sekonder (p=0,608) patensi ile teknik (p=0,145) ve klinik (p=0,145) başarı bakımından anlamlı farklılık saptanmadı.
Tartışma: Diyaliz fistül trombozlarının perkütan tedavisinde kullanılan standart doz ile tromboze segment uzunluğuna göre ayarlanan doz yaklaşımları arasında teknik ve klinik başarı ile patensi anlamında farklılık saptanmamıştır.

References

  • 1. Charmaine E. Lok, Thomas S. Huber, Timmy Lee, Surendra Shenoy, Alexander S. Yevzlin, Kenneth Abreo et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. American Journal of Kidney Diseases. 2020;75(4):S1-S164.
  • 2. Agarwal AK, Haddad NJ, Vachharajani TJ, Asif A. Innovations in vascular access for hemodialysis. Kidney International. 2019;95(5):1053-63
  • 3. Kitrou P, Papasotiriou M, Katsanos K, Karnabatidis D, Goumenos DS, Papachristou. Recent developments in endovascular interventions to sustain vascular access patency in haemodialysis patients. Nephrology Dialysis Transplantation. 2019;34(12):1994-2001.
  • 4. Ates OF, Taydas O. Modified lyse and wait technique for the treatment of dialysis fistula thrombosis: Percutaneous thrombolytic therapy with a 27‐G dental needle. Seminars in Dialysis. 2022;35(6):522-7.
  • 5. Regus S, Lang W, Heinz M, Rother U, Meyer A, Almasi-Sperling V, et al. Time-extended local rtPA infiltration for acutely thrombosed hemodialysis fistulas. Hemodial Int. 2018;22(1):31-36. doi:10.1111/hdi.12528
  • 6. Cynamon J, Lakritz PS, Wahl SI, Bakal CW, Sprayregen S. Hemodialysis graft declotting: description of the “lyse and wait” technique. J Vasc Interv Radiol. 1997;8(5):825-829.
  • 7. Kitrou PM, Katsanos K, Papadimatos P, Spiliopoulos S, Karnabatidis D. A survival guide for endovascular declotting in dialysis access: procedures, devices, and a statistical analysis of 3,000 cases. Expert Rev Med Devices. 2018;15(4):283-291. doi:10.1080/17434440.2018.1454311
  • 8. Kitrou PM, Papadimatos P, Spiliopoulos S, Christeas N, Katsanos K, Karnabatidis D. Lysis-Assisted Balloon (LAB) Thrombectomy. A Declotting Technique for the Treatment of Thrombosed Arteriovenous Dialysis Grafts. 5-Year Experience of 241 Endovascular Procedures. Cardiovasc Intervent Radiol. 2018;41(2):245-252. doi:10.1007/s00270-017-1813-z
  • 9. Natalia Vashchenko, Asher Korzets, Chaim Neiman, Gil N. Bachar, Yaacov Ori, Alexander Belenky et al. Retrospective Comparison of Mechanical Percutaneous Thrombectomy of Hemodialysis Arteriovenous Grafts With the Arrow-Trerotola Device and the Lyse and Wait Technique. American Journal of Roentgenology. 2010;194(6):1626-9.
  • 10. Farsad K, Baljendra S. Kapoor, Nicholas Fidelman, Thomas R. Cain, Drew M. Caplin, Jens Eldrup-Jorgensen, et al. ACR Appropriateness Criteria® Radiologic Management of Iliofemoral Venous Thrombosis. Journal of the American College of Radiology. 2020;17(5): S255-S264.
  • 11. Tan RY, Pang SC, Teh SP, Lee KG, Chong TT, Gogna A et al. Comparison of alteplase and urokinase for pharmacomechanical thrombolysis of clotted hemodialysis access. J Vasc Access. 2019;20(5):501-506. doi:10.1177/1129729818819735
  • 12. Samama M, Nguyen G, Desnoyers P, Lourenco D.M, Fretault J, Horellou MH, et al. Comparison of thrombolytic, fibrinolytic, and fibrinogenolytic properties of tissue plasminogen activator, streptokinase, single-chain urokinase, high molecular weight and low molecular weight urokinase in human plasma in vitro. Fundam Clin Pharmacol. 1988;2(6):509-523. doi:10.1111/j.1472-8206.1988.tb00652.x
  • 13. Yilmazsoy Y, Ozyer U. Long-term results of endovascular treatment for arteriovenous dialysis access thrombosis in 143 patients: A single center experience. J Vasc Access. 2019;20(5):545-552. doi:10.1177/1129729819865808
Year 2023, , 537 - 542, 30.12.2023
https://doi.org/10.31832/smj.1347210

Abstract

References

  • 1. Charmaine E. Lok, Thomas S. Huber, Timmy Lee, Surendra Shenoy, Alexander S. Yevzlin, Kenneth Abreo et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. American Journal of Kidney Diseases. 2020;75(4):S1-S164.
  • 2. Agarwal AK, Haddad NJ, Vachharajani TJ, Asif A. Innovations in vascular access for hemodialysis. Kidney International. 2019;95(5):1053-63
  • 3. Kitrou P, Papasotiriou M, Katsanos K, Karnabatidis D, Goumenos DS, Papachristou. Recent developments in endovascular interventions to sustain vascular access patency in haemodialysis patients. Nephrology Dialysis Transplantation. 2019;34(12):1994-2001.
  • 4. Ates OF, Taydas O. Modified lyse and wait technique for the treatment of dialysis fistula thrombosis: Percutaneous thrombolytic therapy with a 27‐G dental needle. Seminars in Dialysis. 2022;35(6):522-7.
  • 5. Regus S, Lang W, Heinz M, Rother U, Meyer A, Almasi-Sperling V, et al. Time-extended local rtPA infiltration for acutely thrombosed hemodialysis fistulas. Hemodial Int. 2018;22(1):31-36. doi:10.1111/hdi.12528
  • 6. Cynamon J, Lakritz PS, Wahl SI, Bakal CW, Sprayregen S. Hemodialysis graft declotting: description of the “lyse and wait” technique. J Vasc Interv Radiol. 1997;8(5):825-829.
  • 7. Kitrou PM, Katsanos K, Papadimatos P, Spiliopoulos S, Karnabatidis D. A survival guide for endovascular declotting in dialysis access: procedures, devices, and a statistical analysis of 3,000 cases. Expert Rev Med Devices. 2018;15(4):283-291. doi:10.1080/17434440.2018.1454311
  • 8. Kitrou PM, Papadimatos P, Spiliopoulos S, Christeas N, Katsanos K, Karnabatidis D. Lysis-Assisted Balloon (LAB) Thrombectomy. A Declotting Technique for the Treatment of Thrombosed Arteriovenous Dialysis Grafts. 5-Year Experience of 241 Endovascular Procedures. Cardiovasc Intervent Radiol. 2018;41(2):245-252. doi:10.1007/s00270-017-1813-z
  • 9. Natalia Vashchenko, Asher Korzets, Chaim Neiman, Gil N. Bachar, Yaacov Ori, Alexander Belenky et al. Retrospective Comparison of Mechanical Percutaneous Thrombectomy of Hemodialysis Arteriovenous Grafts With the Arrow-Trerotola Device and the Lyse and Wait Technique. American Journal of Roentgenology. 2010;194(6):1626-9.
  • 10. Farsad K, Baljendra S. Kapoor, Nicholas Fidelman, Thomas R. Cain, Drew M. Caplin, Jens Eldrup-Jorgensen, et al. ACR Appropriateness Criteria® Radiologic Management of Iliofemoral Venous Thrombosis. Journal of the American College of Radiology. 2020;17(5): S255-S264.
  • 11. Tan RY, Pang SC, Teh SP, Lee KG, Chong TT, Gogna A et al. Comparison of alteplase and urokinase for pharmacomechanical thrombolysis of clotted hemodialysis access. J Vasc Access. 2019;20(5):501-506. doi:10.1177/1129729818819735
  • 12. Samama M, Nguyen G, Desnoyers P, Lourenco D.M, Fretault J, Horellou MH, et al. Comparison of thrombolytic, fibrinolytic, and fibrinogenolytic properties of tissue plasminogen activator, streptokinase, single-chain urokinase, high molecular weight and low molecular weight urokinase in human plasma in vitro. Fundam Clin Pharmacol. 1988;2(6):509-523. doi:10.1111/j.1472-8206.1988.tb00652.x
  • 13. Yilmazsoy Y, Ozyer U. Long-term results of endovascular treatment for arteriovenous dialysis access thrombosis in 143 patients: A single center experience. J Vasc Access. 2019;20(5):545-552. doi:10.1177/1129729819865808
There are 13 citations in total.

Details

Primary Language Turkish
Subjects Health Services and Systems (Other)
Journal Section Articles
Authors

Mustafa Özdemir 0000-0002-1934-5346

Mehmet Ali Durmuş 0009-0008-8181-5987

Publication Date December 30, 2023
Submission Date August 21, 2023
Published in Issue Year 2023

Cite

AMA Özdemir M, Durmuş MA. Diyaliz Fistül Trombozlarının Perkütan Tedavisinde Kullanılacak Trombolitik İlaç Dozu Nasıl Belirlenmeli?. Sakarya Tıp Dergisi. December 2023;13(4):537-542. doi:10.31832/smj.1347210

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