球囊扩张治疗血液透析血管通路狭窄时所需球囊压力分析

The analysis of balloon pressure during percutaneous transluminal angioplasty for hemodialysis access stenosis

目的探讨球囊扩张治疗血液透析血管通路不同位置狭窄时所需的压力差别。方法选择2020年4月~9月于重庆医科大学附属第一医院金山血液透析通路中心就诊并行球囊扩张成形术的血液透析通路患者,收集基本信息、手术资料,并分析不同位置所需的压力区别。结果共259例患者治疗300例狭窄病变,男性102例,女性157例,自体动静脉内瘘242例病变,人工血管动静脉内瘘58例病变。临床成功率100%(300/300),手术成功率98.7%(296/300),手术并发症发生率7.333%,其中血肿形成13例,血管破裂9例。总平均球囊压力(16.693±6.237)atm,达到充分扩张时球囊压力>14atm占58.334%(175/300),自体动静脉内瘘与人工血管内瘘之间、人工血管内瘘不同病变位置之间充分扩张所需压力无显著差异,但自体动静脉内瘘近吻合口区域平均球囊压力(18.467±5.706)atm,高于穿刺区域(t=2.070,P=0.040)和回流静脉(t=4.969,P<0.001)。结论血液透析血管通路狭窄病变对于球囊扩张时达到充分扩张的压力要求更高,不同位置的狭窄所需压力不一,根据这些特点合理选择球囊,方能经济高效地进行腔内介入手术。

Objective To investigate the balloon pressure required during percutaneous transluminal angioplasty(PTA)in the treatment of hemodialysis access stenosis at different locations.Methods Patients with hemodialysis access stenosis and received PTA in Jinshan Hemodialysis Access Center,the First Affiliated Hospital of Chongqing Medical University during April 2020 to September 2020 were enrolled in this study.Demographic and surgical data were collected.The balloon pressure used at different positions was analyzed.Results A total of 259 patients(102 males and 157 females)were enrolled.They had 300 stenosis lesions including 242 in arteriovenous fistulas and 58 in arteriovenous grafts.The clinical success rate was 100%(300/300),the surgical success rate was 98.7%(296/300),and the incidence of surgical complications was 7.333%,including 13 cases of hematoma and 9 cases of vascular rupture.The total mean balloon pressure was 16.693±6.237 atm,and 58.34%(175/300)of the patients used the pressure of>14 atm for full dilation of the lesions.There was no significant difference in pressure required for full dilation between arteriovenous fistulas and arteriovenous grafts,and among different lesion sites in arteriovenous grafts.However,the mean balloon pressure for lesions in juxta-anastomotic sites of arteriovenous fistulas was 18.467±5.706 atm,significantly higher than that for lesions in puncture area(t=2.070,P=0.040)and outflow vein(t=4.969,P<0.001).Conclusion The hemodialysis access stenosis requires higher pressure during PTA to achieve full dilation,and the pressure required at different lesion sites is different.According to these characteristics,appropriate selection of balloon makes the endovascular intervention economical and efficient.