经桡动脉行自体动静脉内瘘功能不良的介入治疗

Transradial intraluminal treatment of dysfunctional arteriovenous fistula in hemodialysis patients

目的探讨经桡动脉行自体动静脉瘘(AVF)腔内成形和(或)溶栓治疗的可行性。方法于因AVF狭窄或血栓闭塞而需行介入治疗的患者中,选取经桡动脉入路介入治疗的8例患者进行回顾性分析。结果首次造影证实6例患者为AVF重度狭窄,即刻行腔内球囊成形术,术后狭窄程度改善;对2例急性血栓形成患者行动脉内溶栓治疗,次日复查造影示血栓溶解,其中1例溶栓后造影显示吻合口附近静脉狭窄严重,行PTA治疗,另1例狭窄程度较轻者未进一步PTA治疗。对8例患者随访2~13个月,其中7例可正常行AVF透析,1例单纯PTA治疗患者2个月后再次行PTA治疗,4个月后因AVF功能不良而改行颈内静脉插管透析。结论经桡动脉行AVF功能不良的介入治疗有一定的可行性。

Objective To explore the feasibility of angioplasty and/or thrombolysis of dysfunctional arteriovenous fistula （AVF） in hemodialysis patients via transradial approach. Methods Totally 8 hemodialysis patients with dysfunctional AVF due to narrow or thrombosis occlusion were salvaged by transradial intraluminal treatment. The data were retrospectively analyzed. Results Six cases were confirmed severe stenosis for the first angiography, and immediate transradial artery angioplasty （PTA） were performed, and then the stenosis were relieved obviously after PTA. The other 2 patients with acute thrombus were treated with transarterial thrombolysis, and the thrombus was dissolved next day demonstrated by angiography, one patient was treated by PTA because of stenosed lumen, another patient was without intervention. Eight patients were followed up for 2-13 months. The blood flow of AVF was sufficient for hemodialysis in 7 patients, and 1 case was treated again with PTA after 2 months, and had to change access to central venous catheter after 4 months because of insufficient blood flow. Conclusion Transradial approach for the intraluminal treatment of dysfunctional AVF is feasible.