经皮血管腔内成形术在前臂动静脉瘘狭窄患者的应用

Application of percutaneous transluminal angioplasty in treating forearm arteriovenous fistula stenosis

目的观察超声引导下经皮血管腔内成形术(PTA)治疗前臂动静脉瘘(AVF)狭窄患者的临床效果。方法前臂AVF狭窄患者32例在B超引导下行PTA治疗,评估内瘘狭窄相关指标的变化,计算内瘘通畅率。结果与术前比较,术后AVF狭窄血管内径(D)增大,峰值流速(Vmax)减少,肱动脉血流量及透析充分性均提高(P<0.05);术后即刻、1 d和3 d的AVF狭窄血管D和横断面积(S)均增加(P<0.05),狭窄部位Vmax和肱动脉阻力指数(RI)均降低(P<0.05)。与术后即刻比较,术后1 d和3 d的AVF狭窄血管D和S增加,Vmax和肱动脉RI降低(P<0.05)。32例患者术后3、6个月内瘘通畅率分别为96.88%、87.50%。术后不良反应总发生率为6.26%;1例为渗出,1例为周围肿胀,经对症处理后症状改善良好。结论超声引导下PTA用于前臂AVF狭窄患者治疗能有效、及时修复前臂AVF狭窄,操作简单、安全。

Objective To observe the clinical efficacy of ultrasound-guided percutaneous transluminal angioplasty(PTA)in the treatment of forearm arteriovenous fistula(AVF)stenosis.Methods Thirty-two patients with forearm AVF stenosis were treated with ultrasound-guided PTA.The internal fistula stenosis-related indexes were observed and the patency rate of internal fistula was calculated.Results Compared with before,the diameter of AVF stenosis was increased,the peak flow velocity(Vmax)was reduced,and the brachial artery blood flow and dialysis adequacy were improved significantly after operation(P<0.05).Compared with before,the diameter and cross-sectional area of AVF stenosis were significantly increased and the Vmax and brachial artery resistance index were significantly decreased at the times of immediately after operation,and one day and three days after operation(P<0.05).The changes at the times of one day and three days after operation were more than those at the time of immediately after operation(P<0.05).The patency rates of fistula in the 3rd and 6th month after operation were 96.88%and 87.50%,respectively.The total incidence of postoperative adverse responses was 6.26%,including exudation in one case and peripheral swelling in one case,which were improved after symptomatic treatments.Conclusion Ultrasound-guided PTA for the treatment of AVF stenosis can repair the forearm AVF stenosis effectively and timely with the advantages of simplicity and safety.