超声指导下介入治疗动静脉内瘘狭窄的应用

Application of treating stenosis of arterio-venous fistulas with percutanous transluminal angioplasty under ultrasound guiding

目的探讨在超声指导下对动静脉内瘘(arterio-venous fistulas,AVF)狭窄的维持血液透析(hemodialysis,HD)患者进行经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)对手术即刻及远期疗效的影响。方法选择2011年1月至2013年1月在广州市第一人民医院因AVF狭窄或闭塞住院并接受PTA介入治疗的慢性肾功能衰竭HD患者62例,分为对照组32例及超声组30例。对照组患者实施常规PTA,超声组患者则在超声指导下进行PTA。PTA术后对患者随访1年,记录随访期间AVF主要心血管事件(包括急性、亚急性血栓形成;扩张部位再狭窄、闭塞需再次PTA或外科造瘘;新发生的AVF狭窄致HD不充分)。结果与对照组相比,超声组穿刺时间、PTA手术时间显著减少,差异有统计学意义[(5.41±1.92)min vs.(8.40±5.61)min,P<0.01;(62.83±13.43)min vs.(71.56±17.98)min,P<0.01]。超声组穿刺并发症发生率降低且手术即时成功率有高于对照组趋势,但差异无统计学意义(3.3%vs.15.6%,P>0.05;96.6%vs.87.5%,P>0.05)。超声组术后超声多普勒AVF瘘口血流量显著高于对照组,差异有统计学意义[(537.62±33.09)m L/min vs.(519.25±35.06)m L/min,P<0.01]。Kaplan-Meier曲线分析结果显示,超声组随访期间无AVF主要心血管事件发生,其生存率显著高于对照组,差异有统计学意义(90.0%vs.65.6%,Log rank=4.706,P=0.030)。结论应用超声指导PTA处理AVF狭窄方便、安全,缩短手术操作时间并能改善手术即刻及远期疗效,具有一定的临床推广应用价值。

Objectives To investigate the immediate and long term outcomes of treating stenosis of arterio-venous fistulas （AVF） with percutanous transluminal angioplasty （PTA） guided by ultrasound.Methods A total of 62 patients with chronic renal failure （CRF） who accepted maintenance hemodialysis （HD） were enrolled.These patients hospitalized in Guangzhou First People＇s Hospital for stenosis of AVF which lead to poor HD effects and treated with PTA.According to whether the ultrasound was used in guiding procedure of PTA,patients were divided into two groups：control group including 32 cases and ultrasound group including 30 cases.After PTA,patients were followed up for 1 year and major adverse vascular events（MAVE） of AVF were recorded.Results Compared with control group,patients in ultrasound group cost less puncture duration and procedure duration of PTA [（5.41 ± 1.92） min vs.（8.40 ±5.61） min,P＜0.01 ; （62.83± 13.43） min vs.（71.56± 17.98）min,P＜0.01].Moreover,patients in ultrasound group had higher successful rate of PTA,less complications of puncture and better blood flow volume of AVF after PTA treatments[3.3％ vs.15.6％,P＞ 0.05; 96.6％ vs.87.5％,P＞0.05; （537.62±33.09）mL/min vs.（519.25±35.06） mL/min,P＜0.01].After 1 year of fellow-up,Kaplan-Meier survival analysis showed there was no MAVE of AVF accured in ultrasound group and the survival rate was higher in ultrasound group than in control group （90.0％ vs.65.6％,Log rank=4.706,P=0.030）.Conclusions Applying ultrasound to guide PTA for CRF patients with serious stenosis of AVF not only make the procedure safer and more convenience,but also reduce procedure duration and improve immediate and long term out-comes of PTA.