高压球囊治疗人工血管动静脉内瘘狭窄的初步体会

The use of high pressure balloon in the treatment of arteriovenous graft stenosis

目的总结高压球囊治疗人工血管动静脉瘘狭窄的临床效果及应用体会。方法回顾性分析仁济医院血管外科应用高压球囊行球囊扩张术治疗人工血管动静脉瘘狭窄病例的治疗效果,通畅率及并发症。结果自2013年3月至2013年11月共计治疗24例病例,男7例,女17例,平均年龄65.9±14.6岁。病变部位人工血管静脉吻合口狭窄占60%,人工血管内狭窄占33.4%。球囊扩张技术成功率100%,扩张压力10~18atm,无出血等并发症。6个月血透通路初级通畅率75%。术后6个月狭窄部位初级通畅率为69.8%±9.5%,初级辅助通畅率分别为91.3%±5.9%。结论高压球囊是提高人工血管动静脉瘘狭窄病变球囊扩张术技术成功率的保障,尤其是人工血管内的狭窄。但是术后通畅率的提高,有赖于加强术后访视以及更多新技术、新材料的应用。

Objectives To summarize the clinical experience and outcome of the endovascular treatment of arteriovenous graft stenosis by high pressure balloon. Methods All the cases of arteriovenous graft stenosis treated by high pressure balloon in our department were analyzed retrospectively. The efficacy, patency and complication rate were followed. Results From Mar 2013 to Nov 2013, 24 cases（mean age of 65.9 ± 14.6yrs, 7 males and 17 females） were treated. 60% of the lesions were graft- to- vein anastomosis stenosis and33.4% of the lesions were intra-graft stenosis. The technical success rate was 100%, and the inflation pressure was 10-18 atm, without complications. The 6-month primary patency of circuit was 75%. The 6-month primary lesion patency was 69.8±9.5%, and primary assistant lesion patency was 91.3±5.9%. Conclusions The results suggest that the high pressure balloon is effective for the treatment of arteriovenous graft stenosis with a better technical success rate. However, a longer patency depends on the postoperative surveillance and new materials and techniques.