腔内血管成型术治疗动静脉内瘘狭窄

Percutaneous transluminal angioplasty for stenosis in hemodialysis arteriovenous fistula

目的:探讨经皮穿刺腔内血管成型术治疗血液透析用动静脉内瘘狭窄的效果。方法:经血管造影或CT血管造影检查,慢性维持血液透析患者的动静脉内瘘狭窄超过50%,或狭窄部位血管内径<2.5mm作为治疗对象。按扩张后的目标血管内径与球囊直径1∶1.1的比例,选用相应直径的扩张球囊。局麻下,经皮穿刺建立血管通道,在放射监测下将扩张球囊置于狭窄部位,缓慢充气至目标值后,保留30s后缓慢放气。21例符合上述条件的患者共进行46例次治疗。结果:技术和临床成功率均为100%。狭窄部位血管内径均扩张至与之相连的正常血管内径。近动脉吻合处狭窄的患者,血流量由扩张前的(157.46±26.43)ml/min增加至(353.26±16.73)ml/min。静脉吻合口狭窄的患者,在血流量为250ml/min时,静脉压由扩张前的(211.33±14.18)mmHg降至扩张后的(102.12±12.42)mmHg。无血管破裂、出血和血栓形成并发症出现。结论:用扩张球囊经皮穿刺腔内血管成型术是治疗动静脉内瘘狭窄安全、有效的方法,它的临床应用将会显著提高血液透析用动静脉内瘘开通率。

Objective：To assess the efficacy of percutaneous transluminal angioplasty （PTA） in arteriovenous fistula stenosis. Methodology：Twenty one end-stage renal failure patients with maintenance hemodialysis were evaluated by angiography or CT angiography to identify the stenosis of 50% or more,or a stenotic area was not more than 2.5 mm in diameter in their arteriovenous fistula. The stenosis were treated by the balloon with use of a maximum of a 1∶1.1 ratio between expected vessel diameter and balloon diameter. Under local anesthesia arteriovenous fistula was canulated with the direction to the stenosis. From the canulation site,the 0.018-inch guidewire was generally passed across the stenosis,over which the balloon was introduced to the stenosis. The balloon was inflated slowly with 2 seconds per atmosphere. Deflation was similarly carried out slowly. Results：The technical and clinical success rate was 100%. The volume of blood flow increased from preintevention （157±26.4）ml/min to postintervention （353±16.7）ml/min. The level of venous pressure decreased from preintervention （211±14.2）mmHg to postintervention （102±12.4）mmHg when the blood flow was at a rate of 250 ml/min. No puncture site bleeding,vascular perforation and thrombosis were observed. Conclusion：PTA is effective and safe for the management of arteriovenous fistula stenosis in patients with maintenance hemodialysis.