透析通路再狭窄不同手术处理

Different surgical methods for the treatment of dialysis access restenosis

目的总结评价开放手术、腔内介入术和复合手术治疗血液透析通路动静脉内瘘再狭窄或闭塞的可行性和安全性。方法回顾性分析2012年1月至2013年12月接受不同手术治疗的24例透析通路动静脉内瘘再狭窄或闭塞患者。其中介入手术10例．开放手术12例，复合手术2例。术后随访3～20个月，平均12个月，评估血流量、狭窄程度、透析时流量及并发症发生情况。结果24例动静脉内瘘再狭窄或闭塞患者术后透析通路血管搏动及震颤恢复正常。透析流量满意。复查彩色超声均显示狭窄处解除，血液流速恢复。随访期间无再次狭窄或闭塞发生，瘘口流量可满足透析需要；无心功能异常或肢体远端缺血、严重肿胀等并发症发生。结论不同手术方法治疗动静脉内瘘再狭窄或闭塞效果确切、安全，透析通路长期通畅率良好。

Objective To evaluate the safety and feasibility of open surgery, endovascular intervention and complex surgery in treating arteriovenous fistula restenosis or occlusion. Methods The clinical data of 24 patients, who received different surgical treatments for restenosis or occlusion of arteriovenous fistula that was used for hemodialysis during the period from January 2012 to December 2013, were retrospectively analyzed. Among the 24 patients, endovascular intervention was employed in 10, open surgery in 12, and complex surgery in 2. The patients were followed up for 3-20 months, with a mean of 12 months. The blood flow, stenosis degree, flow rate during hemodialysis and complications were evaluated. Results After the treatment, the vascular pulsation and the tremor of the dialysis pathway returned to normal in all the 24 patients with restenosis or occlusion of arteriovenous fistula, and the dialysis flow was satisfactory. Color ultrasound reexamination showed that the stenosis was relieved, the blood flow rate returned to normal. During the follow-up period no restenosis or occlusion was observed. The blood flow of the fistula could meet the need of dialysis. No complications, such as cardiac dysfunction, distal limb ischemia, severe swelling, etc. occurred. Conclusion For the treatment of dialysis access restenosis, all the open surgery, the endovascular intervention and the complex surgery are safe and effective. The long-term patency rate of dialysis access is quite satisfactory.