切割球囊治疗高压球囊扩张失败的狭窄闭塞人工血管内瘘的疗效分析

Analysis of clinical effect of cutting balloon angioplasty in hemodialysis graft stenosis or occlusion after high-pressure balloon angioplasty failure

目的探讨切割球囊治疗高压球囊扩张失败的狭窄闭塞人工血管内瘘(AVG)的有效性和安全性。方法回顾性分析2017年1月至2019年2月广州医科大学附属第二医院血管外科高压球囊扩张狭窄闭塞AVG病变失败(残留狭窄>50%)后续采用切割球囊治疗的32例患者的病例资料,统计分析狭窄闭塞位置,术后即时、3、6、12个月通畅率及技术并发症情况。结果共32例患者,其中主要狭窄病变位于人工血管静脉吻合口27例(84.38%),静脉吻合口合并人工血管穿刺点2例(6.25%),静脉吻合口合并动脉吻合口2例(6.25%),头静脉弓1例(3.13%)。切割联合高压球囊治疗成功30例,技术成功率93.75%(30/32),另2例(6.25%,静脉吻合口端闭塞)经切割、高压球囊扩张后使用覆膜支架。切割球囊破裂发生2例(6.25%),无切割球囊相关性血肿或动脉瘤发生。随访(9.4±0.8)个月,治疗后3、6、12个月初始通畅率分别为90.63%(29/32)、59.38%(19/32)、28.13%(9/32),辅助通畅率分别为100.00%(32/32)、84.38%(27/32)、65.63%(21/32)。结论高压球囊开通AVG狭窄闭塞病变失败可采用切割球囊提高内瘘寿命,其3、6个月通畅率、安全性较高,但中长期通畅率的进一步提高有赖于新技术、新材料的应用。

Objective To investigate the efficacy and safety of percutaneous cutting balloon(PCB)angioplasty for the treatment of hemodialysis arteriovenous graft(AVG)stenosis or occlusion after to high-pressure balloon angioplasty failure.Methods From January 2017 to February 2019,32 cases of AVGs stenosis or occlusion treated with PCB in our department after failure of high-pressure balloon angioplasty(residual stenosis>50%)were enrolled,positions and numbers of stenosis,and immediate,3,6 and 12-month patency rate were recorded.Results A total of 32 patients,the main lesions were located at the graft-to-vein anastomosis in 27 cases(84.38%),puncture points of artificial graft in 2 cases(6.25%),graft-to-artery anastomosis in 2 cases(6.25%),and arch of cephalic vein in 1 case(3.13%).Thirty cases were successfully treated by cutting balloon combined with high-pressure balloon,the technical success rate was 93.75%(30/32),other 2 cases(6.25%)were combined with covered stent implantation.There were 2 cases(6.25%)of cutting balloon rupture,without hematoma or aneurysm formation.The follow-up time was(9.4±0.8)months.The primary patency rate was 90.63%(29/32)at 3 months,59.38%(19/32)at 6 months and 28.13%(9/32)at 12 months after treatment.The patency rate of 3,6 and 12 months were 100%(32/32),84.38%(27/32),65.63%(21/32),respectively.Conclusion PCB can improve the service life of AVGs after fuilure of high-pressure balloon angioplasty.The patency rate and safety are relatively higher in 3 and 6 months,but further improvement mid-and long-term patency requires new technologies and materials.