血液透析动静脉内瘘血管狭窄和闭塞的介入治疗

Interventional treatment for arteriovenous fistula stenosis and occlusion in hemodialysis

目的探讨经导管溶栓、经皮血管成形术(PTA)治疗血液透析动静脉内瘘狭窄和闭塞的可行性和有效性。方法对25例自体血管血液透析动静脉瘘道狭窄和闭塞患者行血管造影,18例血栓形成闭塞患者经导管尿激酶溶栓治疗,16例血管狭窄行PTA。结果 25例造影显示血栓闭塞18例,单纯性狭窄7例;经溶栓治疗开通16例,即时开通率88.9%(16/18)。溶栓开通16例中9例显示血管狭窄,该9例与单纯性狭窄7例共16例进行了PTA治疗,成功14例,失败2例,术后所有病例未发生肺梗塞、出血等并发症。溶栓完全开通或PTA成功后,即感血管震颤较前明显增强,次日透析时血流量达到250mL/min,可完全满足透析需要。结论经导管溶栓和PTA是治疗动静脉内瘘血栓形成和血管狭窄的安全、有效和微创的方法,经导管溶栓具有较高的开通率;对栓塞伴有血管狭窄的患者,在溶栓的基础上,结合PTA可提高远期开通率。

Objective To study feasibility and efficacy of catheter directed thrombolysis and percutaneous transluminal angioplasty（PTA） treatment of hemodialysis arteriovenous fistula stenosis and occlusion.Methods Twenty-five patients with failure and malfunction hemodialysis access were examined by angiography and treated by interventional management subseqently.Eighteen patients with thrombosis occlusilon were treated with thrombolytic therapy and 16 cases of malfunctioning hemodialysis access underwent PTA.Results The initial angiogram showed 18 patients with thrombosis occlusion and 7 patients with simple vascular stenosis.The catheter directed thrombolysis was successful in 16 of 18 cases,the immediate recanalization rate was 88.9%（16/18）.Anyway,9 of them were found to be complicated with vascular stenosis.Following PTA was performed on them together with the other 7 cases of simple stenosis.The operations were successful in 14 patients,2 patients confronted failure.No patients had postoperative complications such as pulmonary infarction,hemorrhage,etc.The vascular tremor was obviously stronger than before immediately after successful intervention.The blood flow reached 250 mL/min in the next day,which could fully meet the requirment of dialysis.Conclusion Catheter directed thrombolysis and PTA are safe,effective and minimally invasive methods for arteriovenous fistula thrombosis and vascular stenosis,considering its high opening rate;for patients complicated with vascular stenosis,thrombolysis combined with PTA can improve the long-term patency rate.