超声引导经皮腔内血管成形术治疗血液透析患者自体动静脉内瘘狭窄

Ultrasound-guided Percutaneous Transluminal Angioplasty in the Treatment of Arteriovenous Fistula Stenosis in Hemodialysis Patients

目的探讨超声引导经皮腔内血管成形术(PTA)治疗血液透析患者自体动静脉瘘(AVF)狭窄的疗效和临床应用价值。资料与方法选取因AVF狭窄或闭塞行超声引导PTA治疗的慢性肾功能衰竭维持血液透析患者196例,PTA治疗333例次,比较手术前后血管狭窄处内径、肱动脉流量,记录手术技术成功率及临床成功率及并发症情况。结果超声引导PTA前后血管狭窄处内径分别为(1.91±0.91)mm、(3.12±1.20)mm,肱动脉流量分别为(147.43±121.52)ml/min、(917.81±435.82)ml/min,差异均有统计学意义(P<0.01),技术成功率为88.8%(174/196),临床成功率为83.7%(164/196)。术后并发症主要包括血栓形成19例、血管塌陷回缩4例、出血14例、假性动脉瘤4例、真性动脉瘤1例、夹层动脉瘤1例、血管破裂3例。结论超声引导PTA治疗AVF狭窄安全、有效、成功率高,为临床治疗提供了一种新思路。

Purpose To investigate the efficacy and clinical application value of percutaneous transluminal angioplasty(PTA)in the treatment of ateriovenous fistula(AVF)stenosis in hemodialysis patients.Materials and Methods One hundred and ninety six maintenance hemodialysis patients with chronic renal failure treated with interventional ultrasound PTA due to AVF stenosis or occlusion were selected,333 cases were treated with PTA,the internal diameter of stenosis and the flow of brachial artery before and after operation were compared,the technical success rate and clinical success rate of the operation were counted,and the complications were recorded.Results Before and after interventional ultrasound PTA,the internal diameter of stenosis were(1.91±0.91)mm and(3.12±1.20)mm,respectively;and the flow of brachial artery were(147.43±121.52)ml/min and(917.81±435.82)ml/min,respectively,the difference was statistically significant(P<0.01),with the technical success rate of 88.0%(174/196)and clinical success rate of 83.7%(164/196).Postoperative complications mainly included thrombosis(n=19),vascular subsiding and recoil(n=4),hemorrhage(n=14),pseudoaneurysm(n=4),true aneurysm(n=1),dissection aneurysm(n=1)and vascular rupture(n=1).Conclusion Interventional ultrasound PTA is safe,effective and successful in the treatment of AVF stenosis,and provides a new thought for clinical treatment.