前臂自体动静脉瘘重度狭窄病变的腔内治疗体会

Experience in endovascular treatment of severe stenosis of forearm autogenous arteriovenous fistula

目的探讨前臂自体动静脉瘘(AVF)重度狭窄血管腔内治疗中瘘口的确定及导丝导管通过病变的方法及技巧。方法利用前臂自体AVF解剖学特点来进行瘘口的定位,利用微导丝塑形和微导管及微球囊的特点来通过重度狭窄闭塞的瘘口,完成了14例AVF瘘口重度狭窄甚至闭塞患者的腔内治疗。通过对比扩张前后的瘘口震颤程度、血管造影所见的血管狭窄程度的变化、彩色多普勒超声、术后透析时流量变化,评价本治疗方法的疗效。结果 14例患者均取得技术成功,术中造影见AVF狭窄明显改善,狭窄程度均降至20%以下,术后瘘口处震颤明显增强,透析时流量明显增加,并达到透析所需(均>220 ml/min)。结论利用前臂自体AVF解剖学特点来进行瘘口的定位,利用微导丝塑形和微导管及微球囊的特点来通过重度狭窄闭塞的瘘口的方法可以解决前臂自体AVF的重度狭窄无法顺行通过的问题,可以供临床参考,使得更多的透析患者获益。

Objective To explore the methods and skills to confirm fistula location and pass through severe stenosed lesions during endovascular treatment of forearm autogenous arteriovenous fistula（AVF）stenosis. Methods Fistula position was identified according to anatomical features of forearm autogenous AVF. And the fistula and lesions was crossed by shaping the micro-guide wire and properly using micro catheter and micro balloon. Fourteen cases of severe AVF stenosis or occlusion were successfully fixed via endovascular treatment. Pre-and post-operative variables, including degree of tremor and vascular stenosis,blood flow in color Doppler ultrasound and dialysis flow, were compared to evaluate the effect of these approaches. Results All cases were successful cured via the above method. Recovered or stronger tremors were achieved in all the AVF. The intraoperative angiography showed that the residual stenosis was less than20%, and the blood flow was markedly improved as shown by color Doppler ultrasound. Furthermore, the postoperative dialysis flow increased significantly and achieved the required level（220 ml/min）. Conclusion The recommended methods in this study can solve the problem of the severe stenosis of the forearm autogenous AVF, which could be referenced and benefit patients requiring dialysis.