Fogarty导管在小直径静脉的自体动静脉内瘘术中的应用

Studies on using fogarty catheter in the establishment of autogenous internal arteriovenous fistula with small diameter vein B I

目的评价应用Fogarty动脉取血栓导管辅助建立静脉直径小于2mm且≥1．4mm的自体动静脉内瘘手术的临床效果。方法选择2012年1月至2014年1月82例首次行自体动静脉内瘘术、彩色多普勒超声及术中测量动脉直径≥21T11TI患者。彩色多普勒超声及术中测量头静脉直径〈2mm患者35例纳入研究组，头静脉直径≥2mm患者47例纳入对照组。研究组应用Fogarty动脉取血栓导管的球囊全程扩张纤细的静脉后再行自体动静脉内瘘建立术，术中将3F-Fogorty动脉取血栓导管插入静脉，向球囊注入肝素盐水，缓慢、持续地向外拉出导管扩张静脉，术后予抗凝治疗。对照组按传统方法行自体动静脉内瘘建立术。术后观察内瘘的情况，初次应用内瘘时间，血液透析时的流量，术后6个月内瘘成熟、并发症及干预措施等情况。结果82例患者完成术后随访6个月，79例患者开始应用内瘘穿刺行血液透析。6个月内瘘成熟率研究组与对照组分别为97．1％、95．7％。6个月初次通畅率研究组与对照组分别为94．3％、97．9%.6个月累积通畅率研究组与对照组分别为94．3％、97．9％。结论研究组与对照组患者的内瘘手术成功率、内瘘成熟率、初次通畅率、累积通畅率无明显差异，但远期通畅率尚需观察。

Objective We intend to evaluate the clinical effect after the operation of establishment of autogenous internal arteriovenous fistula with vein diameter 〈 2 mm with the use of Fogarty arterial embotectomy catheter. Methods From January 2012 to January 2014, the 82 patients who first built in- ternal arteriovenous fistula and whose arterial diameter≥ 2 mm measured at color Doppler ultrasound and measured during operation are chosen as the subjects of the study. 35 patients of whom with cephalic vein dianleter measured at color doppler ultrasound and measured during operation〈2 turn are regarded as the experiment group and the other 47 of whom with cephalic vein diameter ≥2 mm are regarded as the con- trol group. The experimental group of patients is provided with balloon whole-process dilatation of thin vein with the use of Fogarty arterial embolectomy catheter before internal arteriovenous fistula operation. The control group is provided with operation of establishment of internal arteriovenous fistula in the tradi- tional way. Results After six months of the post-operation follow-up of the 82 patients, we find that 79 of them start to accept the hemodialysis with internal fistula puncture. In the six months, the rate of ma- ture of internal fistula of the patients from the experimental group and the control group is 97. 1 % and 95.7% respectively. The patency rate of the two groups is 94.3% and 97.9% and so is the cumulative patency rate for the two groups of patients respectively. Conclusions The success rate of the internal fis- tula operation, rate of mature of the internal fistula, first patency rate and cumulative patency of the pa- tients in the experimental and control group are no obvious difference, but further observation of long- term pateney rate is still required.