正確的血管去血栓手術﹣術中影像檢查是必要的。

在2006年美國的K/DOQI guideline中,在vascular access的部份,己經將術中的影像檢查(intraprocedure image study)列為透析血管去血栓術建議要加作的,原因是,大部份的血管都有其潛在原因啊!
所以,各位從事透析血管通路維持手術的外科醫師,術中血管攝影已經成為一項必備的技巧了。只要多花個十分鐘,就可以保障自己的手術成果,儘量維持好的術後暢通,用處很大的!

Guideline是這麼寫的:

6.7 Treatment of thrombosis and associated stenosis: Each institution should determine which procedure, percutaneous thrombectomy with angioplasty or surgical thrombectomy with AVG revision, is preferable based upon expediency and physician expertise at that center.
  • 6.7.1 Treatment of AVG thrombosis should be performed urgently to minimize the need for a temporary HD catheter. (B)
  • 6.7.2 Treatment of AVG thrombosis can be performed by using either percutaneous or surgical techniques. Local or regional anesthesia should be used for the majority of patients. (B)
  • 6.7.3 The thrombectomy procedure can be performed in either an outpatient or inpatient environment. (B)
  • 6.7.4 Ideally, the AVG and native veins should be evaluated by using intraprocedural imaging. (B)
  • 6.7.5 Stenoses should be corrected by using angioplasty or surgical revision. (B)
  • 6.7.6 Methods for monitoring or surveillance of AVG abnormalities that are used to screen for venous stenosis should return to normal after intervention. (B)
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