中南大学湘雅医院动静脉内瘘彩超引导球囊成形术的现状分析

Situation of AVF Ultrasound-guided PTA in Xiangya Hospital Central South University

目的:了解桡动脉-头静脉AVF狭窄或血栓闭塞的影响因素及好发部位,明确彩超引导PTA的疗效及治疗后通畅率。方法:选取中南大学湘雅医院2019年1月~2020年1月,因桡动脉-头静脉AVF成熟后流量功能不良(狭窄或血栓闭塞)行彩超引导PTA治疗的患者,对术前术后彩超评估指标进行分析。结果:30名患者原发病以糖尿病肾病为主(50.0%)。狭窄或血栓闭塞至瘘口距离为3.5±3.4cm,近吻合口狭窄占73.3%。狭窄患者经彩超引导PTA治疗前后,狭窄血管内径[(1.2±0.5)mm vs(3.4±0.8)mm]和通路血流量[(269.9±123.9)mL/min vs(635.1±299.6)mL/min]均明显改善,血栓闭塞与狭窄患者相比,治疗后血管内径或通路血流量均无明显差异。治疗后通畅率6个月为59.3%,1年为12.5%。结论:在桡动脉-头静脉AVF成熟后定期监测中,应重点关注糖尿病肾病患者,注意近吻合口狭窄。彩超引导PTA疗效显著,即使在血栓闭塞患者中也有很好的效果,但可能需要反复治疗。

Objective: To ascertain factors and characteristic sites of radiocephalic AVF stenosis or thrombotic occlusion, and to clarify the effect and patency of ultrasound-guided PTA. Methods: We selected the patients with mature radiocephalic AVF flow dysfunction visiting Central South University Xiangya Hospital from January 2019 to January 2020 for ultrasound-guided PTA,and analyzed the ultrasound indexes before and after PTA. Results: In 30 patients the primary disease was mainly diabetic nephropathy(50.0%). The distance from the lesion to the anastomosis was 3.5±3.4 cm. Juxta-anastomotic stenosis accounted for 73.3%. In patients with stenosis, the luminal diameter(1.2±0.5 mm vs 3.4±0.8 mm)and access blood flow(269.9±123.9 ml/min vs 635.1±299.6 ml/min)were improved before and after ultrasound-guided PTA. The luminal diameter and access blood flow after PTA had no differences between patients with thrombotic occlusion and stenosis. The patency after ultrasound-guided PTA was 59.3%at 6 months and 12.5%at 1 year. Conclusion: In the regular monitoring of mature radiocephalic AVFs, we should focus on patients with diabetic nephropathy, and pay attention to Juxta-anastomotic stenosis. Ultrasound-guided PTA had a significant effect, even in patients with thrombotic occlusion, but it may be needed repeatedly.