前臂人工血管内瘘术后发生血清肿一例

患者男 ,38岁 ,左前臂桡动脉头静脉内瘘血液透析 5年 ,内瘘狭窄 3月 ,介入治疗失败并致内瘘闭塞 2d来诊手术。手术于左肘 ,间置 6mm× 7cmGore tex人工血管完成前臂肱动脉头静脉人工血管内瘘术。术中见人工血管“出汗”明显。术后 2 4h皮片引流出约 2 0 0 0ml清亮无色液体 ,术后4 8h引流自行停止。术后左肘局部渐隆起 ,不伴红肿 ,患者无寒战发热。术后 15d突发内瘘杂音震颤消失。急诊手术 ,经原手术入路撑开切口立见涌出浆液性液约 2 0ml(积液细菌培养阴性 )。内瘘解除压迫后恢复通畅。继续血液透析治疗。血液透析后左肘包块增大明显 ,需穿…     

经皮腔内血管成形术后内瘘再狭窄的相关危险因素探讨

目的 探讨经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)后再狭窄的相关危险因素,为延长内瘘使用时间提供诊疗依据。方法 回顾性纳入2020年1月1日至2021年1月1日在北京大学第三医院海淀院区肾内科因动静脉内瘘狭窄接受超声引导下PTA治疗并规律随访的血液透析患者335例,收集其基本数据包括基础病史、合并症、相关血清学指标、内瘘手术操作及术后随访资料,采用Cox比例风险模型分析影响PTA术后内瘘再狭窄的危险因素。结果 共纳入335例患者,其中男187例(55.82%),女148例(44.18%)。PTA术后6个月时的初级通畅率为77.31%,12个月时的初级通畅率为50.15%。Kaplan-Meier生存分析结果显示术后12个月,内瘘类型为人工血管动静脉内瘘的患者初级通畅率在随访时间内明显低于自体动静脉内瘘的患者(Log-rankχ²=719.522,P<0.001);陈旧性病变患者的初级通畅率在随访时间内明显低于新发病变的患者(Log-rankχ²=23.106,P<0....     

人工血管动静脉内瘘中远期并发症的处理

目的总结人工血管动静脉内瘘中远期并发症的处理经验。方法分析2009年1月至2014年12月本科65例(71例次)上肢人工血管动静脉内瘘术随访病例资料。结果本组病例失访14例,死亡9例。余42例随访时间为6~66个月,一期内瘘通畅时间1~51个月,平均15.6个月。随访期间内,38例出现内瘘堵塞或流量不足,其中30例患者行人工血管切开取栓术,手术成功率86.7%(26/30),8例患者行经皮腔内血管成形术(PTA)。12例假性动脉瘤形成,其中1例未处理,2例行假性动脉瘤切除+人工血管修补术,3例行假性动脉瘤切除+血管吻合+皮瓣转移修复术,6例行假性动脉瘤切除+血管吻合术。1例反复穿刺部位的人工血管失功,1例动脉吻合口严重狭窄,均予以再次造瘘。3例发生人工血管感染,均行人工血管取出术。结论人工血管动静脉内瘘中远期的并发症主要为内瘘堵塞和假性动脉瘤形成,利用手术和介入的方法可处理人工血管的并发症,加强术后随访,早期干预可提高人工血管动静脉内瘘通畅率。     

腔内修复术治疗感染性主动脉瘤

目的 探讨腔内修复术治疗感染性主动脉瘤(IAA)的方法及其疗效.方法 回顾性分析2006年5月～2007年7月经腔内修复治疗7例IAA患者的临床资料.结果 7例均获得技术成功,术后行数字减影血管造影显示动脉瘤消失,无内漏,术后无并发症.随访8～22个月,瘤体无增大,人工血管支架通畅无移位、无内瘘及感染发生.结论 腔内修复术治疗IAA具有安全、微创等特点,近期疗效较好,远期效果尚需进一步随访.     

血液透析动-静脉造瘘术后并发症的处理

目的 总结血液透析（血透）患者动静脉造瘘手术后并发症的处理经验。方法 收集我院120例患者,造瘘手术144例次,其中行内瘘134例次,人工血管瘘10例次。结果 术后扩要并发症：（1）血栓形成,AVF：17%、AVG：60%。内瘘血栓形成多发生于6周以内,治疗以重建新瘘道为主,或改建人工血管瘘;人工血管瘘血栓以取栓治疗为主,同时尽可能修复静脉流出道。（2）感染,AVG感染率为10%,行引流行移植物切除手术。（3）充血性心功能衰竭：3.5%,超滤、强心治疗。（4）窃血：1.4%,行血管成型和旁路架桥手术治疗。结论 积极预防和正确处理造瘘术后并发症可延长瘘道的通畅时间。     

经人工血管腔内治疗转流后血管通路狭窄

目的 探讨经人工血管径路的血管腔内治疗的安全性与疗效.方法 17例人工血管转流术后患者,16例吻合口狭窄伴有人工血管血栓形成(10例同时有流人道或流出道狭窄),1例仅有流入道狭窄.局麻下,16例(有吻合口狭窄和人工血管血栓形成)在人工血管取栓后行血管腔内治疗;1例直接经皮穿刺人工血管行血管腔内治疗.观察转流血管的通畅情况.结果 13例远端吻合口,1例近端吻合口各置入支架1枚,2例远端吻合口放置支架失败(10例同时行髂动脉、腘动脉、胫后或胫前动脉支架置入或球囊扩张术),1例只行股总动脉支架置入.随访时间为1～35个月,平均为(12±4)个月;2例下肢缺血加重,其中1例出现足部及小腿的坏疽,1周后行膝上截肢术,另1例又行转流术;1例3个月后又出现下肢缺血症状,1例6个月后死于心肌梗死,其他病例血管仍保持通畅.结论 经人工血管径路的血管腔内治疗,创伤小,近期疗效尚可,为处理人工血管转流术后吻合口狭窄、流人道和流出道病变添加了一种方法.     

人工血管动静脉内瘘术后狭窄和闭塞的介入治疗

目的观察介入治疗人工血管动静脉内瘘术后狭窄和闭塞的疗效。方法回顾性分析2013年1月至2014年7月在中山市人民医院采用穿刺溶栓、球囊扩张解除人工血管、吻合口及锁骨下静脉狭窄治疗12例患者的临床资料。结果人工血管动静脉内瘘闭塞主要是狭窄基础上继发血栓形成,平均有(3.5±2.3)处狭窄,介入开通率100.0%。4例发生局部穿刺口渗血,压迫后缓解。随访1年累计通畅率66.67%,2年累计通畅率33.33%。结论介入可有效地治疗人工血管动静脉内瘘术后狭窄和闭塞,延长人工血管动静脉内瘘使用时间。     

下肢动脉人工血管旁路术后再闭塞的治疗经验

目的总结治疗下肢动脉人工血管旁路术后再闭塞的治疗经验,探索合理的治疗策略。方法回顾性总结19例下肢动脉人工血管旁路术后再闭塞的病例,分析再闭塞的原因,并根据原因选择再次手术的方式。其中4例行人工血管取栓术,5例行人工血管取栓＋远端吻合口成形术,3例行人工血管取栓＋股深动脉扩大成形术,2例行新的人工血管旁路术,1例行髂外动脉内膜剥脱术,2例行骨髓干细胞移植,2例由于肢体广泛坏死,行1期截肢术。在术后进行规律的随访以明确手术的效果。结果19例患者术后1年中定期随访。除2例截肢外,14例围手术期获得了1期成功,成功率82．4％,3例（17．6％）手术失败,术后1年内死亡2例,病死率10．5％。术后1年随访时,人工血管通畅6例,血管通畅率35．3％,保肢率76．4％（13例）。结论人工血管旁路术后再闭塞的治疗比较棘手,术前有效地评估闭塞原因、选择正确的手术方式和良好的随访计划是保持患者肢体功能和生存质量的重要因素。     

下肢动脉旁路移植术后移植物闭塞的处理

目的 总结分析下肢动脉旁路移植术后移植物闭塞的治疗经验.方法 回顾性分析2002年7月至2009年9月64例单侧下肢动脉旁路移植术后移植物闭塞患者的临床资料.共发生115例次移植物闭塞,其中8例次末次闭塞时行保守治疗,其余107例次行手术治疗,包括单纯人工血管取栓术32例次,再次人工血管旁路移植术27例次,人工血管取栓并球囊成形术17例次,截肢术13例次,人工血管取栓术并腘动脉内膜剥脱术10例次,人工血管闭塞并感染取出后保守治疗4例次,自体大隐静脉远侧旁路移植术3例次,自体干细胞移植1例次.结果 1例患者因术后急性肾功能衰竭死亡,3例随访中死亡.3例末次手术后失访,2例保守治疗失访;55例患者随访4～70个月,平均39个月.其中35例患者移植物通畅(通畅率为63.6%).12例患者移植物闭塞后截肢(21.8%),总保肢率为78.2%.结论 对于下肢动脉旁路移植术后移植物闭塞的患者,再次旁路移植术以及人工血管切开取栓+内膜剥脱术或球囊成形术的近期效果较好.     

人工血管动静脉内瘘术和大隐静脉内瘘术的临床评价

1996年4月-2002年3月，47例尿毒症患者(49肢)接受肱动脉—头静脉人工血管内瘘术和腘动脉-大隐静脉内瘘术。其中40例行肱动脉—头静脉人工血管内瘘术(41肢)，7例行股动脉—大隐静脉内瘘术(8肢)。人工血管内瘘组围手术期4例发生急性心功能不全，死亡1例。平均随访34个月(6—70个月)，1年初始通畅率为82．9％，再手术通畅率为95．1％；2年初始通畅率为67．3％，再手术通畅率为78．4％。初始通畅时间最长的为75个月，最短的为1个月。大隐静脉内瘘组8例无围手术期死亡。平均随访13个月(2-39个月)，1例因脑出血于术后2个月死亡。1例术后6个月血栓形成，再行对侧下肢大隐静脉内瘘术至今33个月，内瘘通畅。其余5例均通畅。人工血管动静脉内瘘术和下肢大隐静脉内瘘术虽有操作复杂、创伤相对较大等缺点，但可以作为传统方法的重要补充，为一部分患者提供一条安全持久的血透通路。     

Integrated approach to construction and maintenance of prosthetic arteriovenous access for hemodialysis

Autogenous arteriovenous access is the preferred access for hemodialysis patients with end-stage renal disease but is not feasible in a significant number of patients. The creation of a prosthetic arteriovenous access (PAVA) for hemodialysis using expanded polytetrafluoroethylene is technically simple and the short-term results are usually good, but the PAVA's 1-year patency rate is low (less than 60% in many centers). We have developed an integrated approach for the creation and maintenance of PAVAs, under the direction of a dedicated vascular access surgeon, involving preoperative imaging, anesthetic and surgical techniques, and a postoperative graft surveillance program, to improve patency rates. The design used was a prospective nonrandomized study. Between January 1, 1999 and December 31, 2001, 158 PAVAs were created (37.7% of the 419 fistulae created during this period). High-resolution duplex ultrasonography was added to careful clinical assessment in planning and follow-up of the dialysis access. The preferred method of PAVA creation was the forearm loop using tapered 4 to 7 mm stretch expanded polytetrafluoroethylene. After surgery, patients entered a program of close follow-up and regular graft surveillance and maintenance. Prophylactic surgical revisions and endovascular interventions were performed routinely according to ultrasonography findings to prevent thrombosis. Thrombolysis and thrombectomy were performed without delay when the PAVA thrombosed, minimizing the use of central venous access and salvaging the central veins. No patients were excluded from the study. One-, 2-, and 3-year assisted primary patency rates (including patients without occlusion but who were judged to require prophylactic revision) were 65%, 54.1%, and 48.8%, respectively. With surveillance-directed surgical revisions and endovascular treatment before or after occlusion, the 1-, 2-, and 3-year secondary patency rates (functional patency) were 91.4%, 84.3%, and 78.5%. Of the 158 grafts, 110 never occluded during the study period. There were 155 interventions in 74 PAVAs: 30 surgical revisions, 63 prophylactic endovascular procedures, and 52 instances of thrombolytic therapy combined with percutaneous transluminal angioplasty. The use of prosthetic arteriovenous access for hemodialysis, when autogenous arteriovenous access is not feasible, can still be associated with excellent long-term patency, in spite of previously published poor results, as long as good planning, close follow-up, and aggressive intervention (when indicated) are carried out.     

Assessing the Approach to a Thrombosed AV Graft

The patency of the vascular access (VA) is a fight for the attending nephrologist. A retrospective observational study was conducted to compare the success rate of surgical versus endovascular technique percutaneous transluminal angioplasty (PTA) for graft thrombosis treatment. Of 3008 patients, 22.1% patients were dialyzed through grafts. Forty‐five percent of all prevalent patients referred due to VA malfunction had a graft. For 18 months, 336 thrombosed grafts were submitted to surgery in 228 cases and to PTA in 126. PTA for thrombolysis included the Pharmaco‐Mechanical Technique and the Arrow‐Trerotola Device. Procedures were performed as outpatient, with an average delay of 1 day. Immediate success was 100% for surgery and 87.3% for PTA. The unassisted patency for thrombosed grafts for surgery/PTAwas 265.12 ± 15.30/230.59 ± 19.83 days respectively, favoring surgery. The primary patency for thrombosed grafts treated by surgery/PTA at 30, 90, and 180 days was, respectively, 74.1%/81%, 63.2%/67.5%, and 53.9%/55.6% all in favor of PTA. AV grafts have a much higher rate of thrombosis than fistulas. Graft thrombosis can be dealt either by surgery or PTA, with identical success.     

Outcomes of Percutaneous Mechanical Thrombectomy of Arteriovenous Fistulas in Hemodialysis Patients

Thrombosis of arteriovenous fistulas is usually superimposed on underlying stenosis in the arterial anastomosis, draining vein, or central vein. Restoring the patency of thrombosed fistulas requires mechanical thrombectomy, in conjunction with angioplasty of the underlying lesion. We evaluated the success rate of percutaneous thrombectomy of fistulas at our medical center. We retrospectively queried a prospective, computerized vascular access database to identify 41 patients with thrombosed fistulas treated percutaneously. Technical success was defined as the ability to use the fistula for at least one dialysis session. Primary patency was defined as time to the next intervention, and secondary failure as the time to permanent fistula failure. Of the 41 thrombosed fistulas, 21 were in the forearm and 20 in the upper arm. Percutaneous thrombectomy was technically successful in 31 of 41 patients (76%). The technical success rate was similar for upper arm and forearm fistulas (85% vs. 66%, p = 0.43). An underlying stenotic lesion was present at the arterial anastomosis in 13 patients (31%), in the draining vein in 37 (90%), and in the central vein in 3 patients (7%). Twelve patients (29%) had concurrent stenoses at two locations. At 6 months, the primary patency was 20%, and the secondary patency was 54%. In conclusion, percutaneous treatment of thrombosed fistulas can restore fistula patency about three‐fourths of patients. However, the primary fistula patency is fairly short‐lived, and the fistulas require repeated interventions to achieve long‐term survival.     

TASCⅡ C、D型股腘动脉闭塞腔内治疗的操作技巧与疗效分析

目的观察TASCⅡ C、D型股腘动脉闭塞腔内治疗的临床疗效,分析影响治疗效果的可能因素与操作技巧。方法 2009年1月～2010年6月,89例(113条患肢)TASCⅡ C、D型股腘动脉闭塞患者接受腔内治疗。对患者术后3、6和12个月时的临床症状、踝肱指数(ABI)、并发症发生率和累计通畅率进行分析。结果成功开通病变肢体共106条,技术成功率93.8%。36条(34.0%)患肢出现并发症。75例患者(共92条下肢)获得随访,随访率为86.8%。平均随访时间12.5个月。术后3、6和12个月时的平均ABI分别为0.74±0.39、0.68±0.38和0.66±0.31,与术前比较(0.43±0.39),差异均有统计学意义(P<0.01)。术后12个月的一期通畅率、辅助通畅率和二期通畅率分别为64.6%、72.4%和81.5%。结论 TASCⅡ C、D型股腘动脉闭塞腔内治疗是一种安全有效的方法。熟练的腔内操作技术和规范的术后指导是提高技术成功率和维持动脉早中期通畅的关键。     

Combination of duplex ultrasound-guided manual declotting and percutaneous transluminal angioplasty in thrombosed native dialysis fistulas

BACKGROUND: To investigate the safety, feasibility, efficacy, and long-term patency rate of manual declotting under duplex ultrasound (US) guidance followed by percutaneous transluminal angioplasty (PTA) in thrombosed native arteriovenous fistulas (AVFs). METHODS: Of 87 consecutive thrombosed AVFs evaluated by duplex US, 22 patients with 25 recently thrombotic events in 22 AVFs were suitable for manual declotting. PTA was performed following successful declotting, and long-term patency was assessed. RESULTS: The procedure success rate of manual declotting was 80% (20 of 25), and a residual stenosis of 74+/-9% was identified by duplex US after declotting. PTA reduced the diameter stenosis to 25+/-6% and increased the lumen diameter from 1.33 +/-0.85 mm to 4.62+/-0.98 mm. Neither embolic nor bleeding complications were noted during the procedure. The average procedure time and the fluoroscopy time were 28.4+/-9.9 and 7.2+/-4.1 minutes, respectively. Primary patency rates at 1, 2, and 3 years were 47%, 35%, and 28%; assisted primary patency rates at 1, 2, and 3 years were 71%, 63%, and 63%; and secondary patency rates at 1, 2, and 3 years were 76%, 71%, and 63%, respectively, during a maximum follow-up period of 42 months. CONCLUSION: The combination of duplex US-guided manual declotting and angioplasty of underlying stenosis is a safe and feasible method to treat recently thrombosed native AVFs in selected patients. It simplifies the interventional procedure, reduces cost and radiation exposure time, and extends life span of dialysis fistula with acceptable long-term patency rate.     

Feasibility of Trans‐Radial Approach in Percutaneous Intervention for Upper Arm Dialysis Access

Background: This retrospective study evaluated the feasibility and efficacy of trans‐radial intervention for upper arm dialysis access. Methods: This study retrospectively reviewed 165 trans‐radial interventions performed for upper arm dialysis access in 101 patients. Sixty‐nine patients had arteriovenous graft (AVG), and 32 had arteriovenous fistula (AVF). Balloon angioplasty was performed in 66 stenotic dialysis accesses and 99 thrombosed dialysis accesses. Thrombosed dialysis access was further managed by additional balloon thrombectomy with or without urokinase injection. Results: Procedural time was 46.7 ± 25.5 minutes. Anatomic and clinical success rates were 89.7% and 84.2%, respectively. The rate of complications, most of which involved lesion rupture with contrast‐media extravasation and distal embolism, was 9.7%. Pretreatment stenosis was more severe (p = 0.01) and the prevalence of total occlusion was higher (p < 0.01) in the AVG group than the AVF group. The success rate and complication rate did not statistically differ (p = 0.59). Additionally, the thrombosed group had a lower success rate (p = 0.02), a higher complication rate (p < 0.01) and a longer procedural time (p < 0.01) than the stenotic group. Conclusions: Comparison with previous studies employing the traditional approach reveals that trans‐radial intervention has a comparable success rate, procedural time and complication rate for upper arm dialysis access. Therefore, trans‐radial intervention is a safe and feasible technique for upper arm dialysis access.     

经皮机械性血栓清除联合导管溶栓与单纯导管溶栓治疗急性下肢缺血的疗效比较

目的比较PMT联合CDT与单纯CDT治疗急性下肢缺血的临床疗效。方法回顾性分析2017年1月至2018年12月苏州大学附属第一医院收治的64例急性下肢缺血患者的临床资料,其中24例行PMT联合CDT治疗(PMT组),40例行单纯CDT治疗(CDT组)。比较两组手术成功率、尿激酶用量、手术时间、溶栓时间、住院时间、住院期间并发症发生率和术后30 d内截肢率、再次手术率及死亡率。结果两组手术均取得成功,技术成功率为100%;PMT组和CDT组的尿激酶用量分别为(56.67±8.16)万U和(106.50±47.56)万U,手术时间分别为(103.33±25.57)min和(72.13±25.74)min,溶栓时间分别为(24.96±12.52)h和(61.20±29.24)h,住院时间分别为(7.13±2.52)d和(9.35±2.65)d,差异均有统计学意义(P<0.01)。两组住院期间并发症发生率(16.7%vs 17.5%)、术后30 d内截肢率(12.5%vs15.0%)、再次手术率(4.2%vs 7.5%)及死亡率(8.3%vs 2.5%)差异均无统计学意义(P>0.05)。不同缺血时间患者的缺血改善情况,两组比较差异均无统计学意义(P>0.05)。结论采取PMT联合CDT治疗急性下肢缺血患者在手术疗效、并发症发生情况结果和单纯CDT相似,但可降低溶栓药物用量、缩短溶栓时间和住院时间。     

Combination of Duplex Ultrasound-Guided Manual Declotting and Percutaneous Transluminal Angioplasty in Thrombosed Native Dialysis Fistulas

Background. To investigate the safety, feasibility, efficacy, and long-term patency rate of manual declotting under duplex ultrasound (US) guidance followed by percutaneous transluminal angioplasty (PTA) in thrombosed native arteriovenous fistulas (AVFs). Methods. Of 87 consecutive thrombosed AVFs evaluated by duplex US, 22 patients with 25 recently thrombotic events in 22 AVFs were suitable for manual declotting. PTA was performed following successful declotting, and long-term patency was assessed. Results. The procedure success rate of manual declotting was 80% (20 of 25), and a residual stenosis of 74 ± 9% was identified by duplex US after declotting. PTA reduced the diameter stenosis to 25 ± 6% and increased the lumen diameter from 1.33 ± 0.85 mm to 4.62 ± 0.98 mm. Neither embolic nor bleeding complications were noted during the procedure. The average procedure time and the fluoroscopy time were 28.4 ± 9.9 and 7.2 ± 4.1 minutes, respectively. Primary patency rates at 1, 2, and 3 years were 47%, 35%, and 28%; assisted primary patency rates at 1, 2, and 3 years were 71%, 63%, and 63%; and secondary patency rates at 1, 2, and 3 years were 76%, 71%, and 63%, respectively, during a maximum follow-up period of 42 months. Conclusion. The combination of duplex US-guided manual declotting and angioplasty of underlying stenosis is a safe and feasible method to treat recently thrombosed native AVFs in selected patients. It simplifies the interventional procedure, reduces cost and radiation exposure time, and extends life span of dialysis fistula with acceptable long-term patency rate.     

腔内治疗髂静脉压迫综合征合并急性下肢深静脉血栓形成的疗效分析

目的探讨腔内治疗髂静脉压迫综合征(iliac vein compression syndrome,IVCS)合并急性下肢深静脉血栓形成(deep vein thrombosis,DVT)的有效性和安全性。方法回顾性收集和分析甘肃省人民医院血管外科2015年6月至2018年6月期间行支架置入与球囊扩张联合AngioJet机械血栓抽吸术治疗IVCS合并急性下肢DVT的57例患者的临床资料。通过患者术前及术后患健膝下15 cm处肢体周径差的变化和术中血栓清除率评价治疗效果。此外,术后依据改良的Villaita量表评分,患者的症状、体征和下肢静脉超声及造影检查统计血栓后综合征(postthrombotic syndrome,PTS)的发生率和髂静脉的通畅率。结果本组患者的手术均顺利,技术成功率为100%;术中及术后均无肺栓塞发生;下肢深静脉血栓清除率达Ⅲ级48例(84.2%),达Ⅱ级9例(15.8%);术后患健侧膝下15 cm处肢体周径差从(5.8±1.7)cm降至(3.7±1.0)cm(P<0.001)。术后随访1年结果:髂静脉狭窄置入支架术后12个月的通畅率为86.0%(49/57);有8例(14.0%)患者发生PTS(Villalta评分>5分)。结论支架置入与球囊扩张联合AngioJet机械血栓抽吸术治疗IVCS合并急性下肢DVT形成是一种安全、有效且易于进行的血管腔内治疗方法,具有高效的血栓清除率和高的通畅率。     

Does early vascular access intervention therapy reduce acute obstruction and reconstruction of arterial-venous fistula?

Acute vascular access (VA) obstruction is one of the most common complications for hemodialysis patients and medical professions. We performed early vascular access intervention therapy (VAIVT) to reduce the incidence of acute VA obstruction, VAIVT and fistula reconstruction. During a 2-year period, we performed 125 procedures of VAIVT in 145 cases in 50 patients who underwent arterio-venous fistula angiography. We performed early VAIVT within two weeks since we clinically found VA stenosis. The 125 procedures of VAIVT (95 non-thrombosed cases, 30 thrombosed cases) involved 86 native fistulas (74 non-thrombosed, 12 thrombosed) and 39 graft fistulas (21 non-thrombosed, 18 thrombosed). Prevalence of thrombosed cases was significantly higher in graft fistula than in native fistula (P<0.001). The primary patency rate in 50 patients at 6, 12 and 24 months was 62.1, 46.9 and 41.7%, respectively, while the secondary patency rate was 93.7, 90.7 and 86.6%, respectively. The highest primary patency rate was found in the non-thrombosed group with native fistula and the lowest secondary patency rate was found in the thrombosed group with graft fistula. By comparing the results of this study with the events for the previous 2 years, the total VAIVT number was almost the same. The number of non-thrombosed cases increased significantly from 54 to 95, and those of thrombosed cases decreased from 68 to 30 (P < 0.001). The number of fistula reconstructions significantly decreased from 59 to 22 (P<0.001). Early VAIVT for VA stenosis could decrease acute VA obstruction and fistula reconstruction without increasing the total number of VAIVT.