介入导管技术在动静脉内瘘失功治疗中的应用

Application of interventional catheterization procedure in arteriovenous fistula dysfunction

目的:探讨动静脉内瘘(AVF)失功后介入手术的治疗方法,评估其治疗效果及应用价值。方法:回顾性分析自2006年4月—2015年1月行介入手术治疗的20例自体AVF失功患者的临床资料。结果:20例患者中,16例经静脉端造影,4例经股动脉-主动脉-腋动脉路径造影;单纯吻合口狭窄4例,行球囊扩张后狭窄明显改善;吻合口狭窄伴血栓形成有5例,切开取栓后再行球囊扩张治疗;静脉端血栓形成3例,切开取栓后返血良好;静脉端狭窄合并血栓形成7例,行切开取栓后再行球囊扩张治疗;头静脉长段闭塞1例,改用人工血管行AVF术。术后全部患者经该血管通路恢复透析治疗,透析时流量均>200 m L/min。共17例患者获得随访,平均随访时间13.2个月,12个月通畅率为47.1%。结论:介入导管技术在治疗AVF失功方面是安全、有效的。

Objective： To investigate the interventional surgery for arteriovenous fistula（AVF） dysfunction and evaluate its therapeutic ef ect and application value. Methods： The clinical data of 20 patients with autogenous AVF dysfunction undergoing interventional treatment from April 2006 to January 2015 were retrospectively reviewed.Results： Among the 20 patients, 16 cases underwent angiography through venous approach, and 4 cases had angiography through femoral/aortic/axillary artery approach; 4 cases had simple anastomotic stenosis that was significantly improved by balloon dilatation, 5 cases had anastomotic stenosis with thrombosis, which was treated by balloon expansion after venous embolectomy; 3 cases had thrombosis at the venous anastomotic site, and good backflow was obtained after embolectomy; 7 cases with venous anastomotic stenosis and thrombosis underwent bal oon angioplasty after venous embolectomy, and one case with long segment stenosis of the cephalic vein was treated by inserting a prosthetic arteriovenous graft. All patients restarted dialysis treatment using the original vascular access, with dialysis l ow greater than 200 mL /min. Follow-up was obtained in 17 patients, with an average follow-up period of 13.2 months, and the 12-month patency rate was 47.1%.Conclusion： Interventional catheterization procedure is safe and ef ective in treatment of AVF dysfunction.