血液透析患者中心静脉狭窄的介入治疗

Interventional treatment of central vein stenosis in hemodialysis patients

目的探讨血液透析患者中心静脉狭窄介入治疗的方法及疗效。方法 2010年5月至2011年11月共收治20例发生中心静脉狭窄的血液透析患者,所有患者均具有中心静脉狭窄的临床症状、体征,并行MRA或CTA明确诊断,经静脉造影明确病变长度、范围和程度,行血管球囊扩张成形术(PTA)对病变部位进行治疗,成形术失败时,行血管支架植入术。术后随访患者的临床症状、MRA、超声等影像学检查。结果所有患者均成功行静脉造影,成功处理了20例患者共17条狭窄静脉,其中成功进行PTA 15例,支架植入成功2例,术后狭窄静脉血管通畅,侧支循环消失。首次PTA后再狭窄发生率为11.8%,再次行P1A。所有手术成功病例随访至今未出现再狭窄。结论血液透析患者中心静脉狭窄的介入治疗安全、有效,静脉通畅率良好。

Objective To evaluate the effectiveness of the interventional treatment for central venous stenosis （CVS） in hemodialysis patients. Methods During the period from May 2010 to Nov. 2011, a total of 20 hemodialysis patients with CVS were referred for angiographic analysis and interventional treatment. All patients had typical clinical signs and symptoms of CVS. MRA or CTA was performed for clarifying the diagnosis. Venography was carried out to determine the length, extent and severity of CVS. Percutaneous balloon dilatation angioplasty was employed to treat the stricture, and endovascular stent placement was adopted when the balloon dilatation angioplasty failed. The therapeutic results were evaluated by the follow-up imaging examinations （MRA, ultrasound, etc.） and the clinical manifestations. Results Venography was successfully accomplished in all patients. A total of 17 obstructed veins in 20 patients were treated. Percutaneous transluminal angioplasty （PTA） was successfully carried out in 15 cases, and stent placement succeeded in 2 cases. After the treatment, all the previously obstructed veins were reopened and the collateral circulation disappeared. The restenosis rate after primary PTA was 11.8%, and PTA had to be employed again. No restenosis was found in successfully treated cases during the follow-up period so far. Conclusion For central venous stenosis in hemodialysis patients, interventional therapy is a safe and effective treatment with a high venous patency rate.