超声引导下腔内介入治疗内瘘血管狭窄

Ultrasound- guided percutaneous transluminal angioplasty for the stenosis in arteriovenous fistulas

目的探讨B超监测下经皮穿刺腔内血管成型术(percutaneous transluminalangioplasty,PTA)治疗动静脉内瘘血管狭窄的效果。方法动静脉内瘘血管经过CT血管造影证实,狭窄发生于四肢血管,狭窄程度≥50%,或血管内径绝对值≤2.5mm,作为B超监测下PTA治疗对象。在B超引导下,沿超滑导丝将扩张球囊送到狭窄血管部位。压力泵以每2秒增加1个大气压的速度向球囊内缓慢注入生理盐水至狭窄消除。结果自2009年6月至2015年12月,共569例患者,进行了1244例次B超监测下PTA,技术成功率98%,临床成功率98%。狭窄血管平均内径,PTA前为(2.094±0.599)mm,PTA后为(3.916±0.720)mm,两者对比有显著差异(t=20.933,P<0.001)。有10例次患者在PTA后出现局部肿胀瘀斑形成,予以弹力绑带轻度加压包扎后消退。未出现血管破裂,血栓形成并发症。结论用B超代替放射监测进行PTA,对设备和场所要求较低,无辐射伤害,亦无需造影剂,同时可实时观察导丝和球囊行进情况和动静脉内瘘血管血流和管腔的变化,是治疗动静脉内瘘狭窄简便、安全、有效的方法。它的主要局限性是只能用于浅表血管,无法对深部血管进行显像引导。

Objective To determine whether percutaneous transluminal angioplasty （PTA） guided by ultrasound is a safe and effective method for treating arteriovenous fistula stenosis in hemdialysis patients. Methods The need for angioplasty intervention was determined by computed tomography angiography （CTA） and duplex ultrasound. Patients with the luminal narrowing ≥50% or the vascular diameter 〈2.5mm were referred to the treatment. The balloon was introduced to the lesion site through a guide wire under the guide of ultrasound. The balloon was then inflated by infusion of normal saline at the pressure increase rate of one atmosphere per 2 seconds until the disappearance of the stenosis. Results A total of 1,244 operations of PTA for 569 patients were performed in our hospital from Jun. 2009 to Dec. 2015. The technical and clinical success rates were 98%. The average vascular diameter was 2.094±0.599mm before the intervention, and was 3.916±0.720mm after the intervention （t=-20.933, P〈0.001）. Local and small amount of extravasation happened in 10 cases, and disappeared within a week after gentle pressure dressing, There was no vessel rupture and-thrombosis due to the PTA manipulation. Conclusion Ultrasound guided PTA for the treatment of arteriovenous fistula stenosis has the advantage of no X-ray radiation, no contrast agent injection, and using rela- tively simple equipment. Ultrasound equipment is also available for vascular imaging and blood flow measurement. PTA under ultrasound guidance for arteriovenou fistula stenosis can be performed safely, simply and effectively, and is a valuable tool for the treatment of superficial vessel stenosis but not for the stenosis in central vein.