经皮血管成形术治疗血液透析动静脉内瘘狭窄或闭塞

Percutaneous transluminal angioplasty for arteriovenous fistula stenosis or occlusion in hemodialysis patients

目的:探讨经皮血管成形术(PTA)治疗血液透析患者动静脉内瘘狭窄和闭塞的临床效果。方法:对16例动静脉内瘘狭窄和闭塞的血液透析患者行PTA治疗,比较PTA治疗前后的血管造影表现、透析时血流量及静脉压的变化情况。结果:术后血管造影显示狭窄和闭塞的血管扩张、再通,触诊感血管震颤增强。术后第2天透析时血流量升高至200ml/min以上,可完成透析,在血流量为250ml/min时静脉压下降为(110.62±15.71)mmHg;其中2例分别在术后3个月和6个月发生再狭窄,再次行PTA后血流量恢复。所有患者均未出现血管破裂、出血、血栓形成等并发症。结论:PTA是治疗动静脉内瘘狭窄和闭塞的有效、安全、微创的方法,可选择适宜的患者采用。

Objective：To observe the clinical effect of percutaneous transluminal angioplasty （PTA） for the treatment of arteriovenous fistula stenosis or occlusion in hemodialysis patients. Methods： PTA was performed in 16 hemodialysis pa tients with arteriovenous fistula stenosis or occlusion. The pre- and post operative angiographic findings, the volume of blood flow, and the level of venous pressure during hemodialysis were compared. Results：The stenotic segment was dilated, the occluded site was re-canalized and the palpation feeling of thrill became stronger immediately after PTA. During the sec ond day of hemodialysis treatment, as the volume of blood flow increased to more than 200ml/min, the procedure of hemodi- alysis could be finished. As the volume of blood flow reached 250ml/min, the venous pressure could decrease to 110.62 ± 15.71mmHg. Recurrent stenosis was found in 2 cases at 3 and 6 months after treatment,the volume of blood flow returned to normal after the second PTA was performed. No complications such as vascular perSoration, hemorrhage and thrombosis were observed. Conclusions：PTA is an effective, safe and micro-invasive treatment for arteriovenous fistula stenosis or occlu sion and could be chosen as the treatment for certain patients with indication.