贯穿导丝技术在尿毒症中心静脉闭塞患者中的应用

The Pull-Through Technique in Endovascular Therapies of Hemodialysis Patients with Central Venous Occlusive Disease

目的 探讨贯穿导丝技术在尿毒症中心静脉闭塞患者中的应用价值。方法 回顾性分析2014年1月至2019年12月诊治的41例中心静脉完全闭塞的尿毒症患者临床资料。所有患者均行腔内介入治疗,术中使用贯穿导丝技术。分析患者手术路径、临床症状改变以及手术成功率。结果 本研究共纳入41例中心静脉闭塞的尿毒症患者,所有患者开通闭塞部位后均成功使用贯穿导丝技术。其中7例患者采用右颈内静脉-股静脉路径,20例患者行右侧肢体内瘘-股静脉路径,14例患者采用左侧肢体内瘘-股静脉路径,术中所有患者均行球囊扩张并支架置入术。术后患者临床症状均明显改善。然而,2例患者术后出现延迟性心包填塞,给予引流后症状好转。结论双入路贯穿导丝技术是一种安全、实用的腔内治疗方法,其能为手术的成功提供重要路径支持,保证了介入手术顺利进行。

Objective To investigate the clinical value of pull-through technique in interventional therapy of hemodialysis patients with central venous occlusive disease(CVOD).Methods A retrospective study was conducted on 41 patients with CVOD treated with endovascular therapies using the pull-through technique from Jan 2014 to Dec 2019.Patients’ demographic data,clinical signs and symptoms pre-procedure and post-procedure were followed up and recorded.Results Successful revascularization of CVOD was adopted with pull-through interventional techniques in 41 cases.Among them,the right jugular-femoral vein access was adopted in 7 patients,the right arteriovenous fistula-femoral vein was accessed in 20 patients,and the left fistula-femoral vein was accessed in 14 patients.All patients underwent balloon dilatation and stent deployment during the operation successfully.The related symptoms were improved within 1 day post-procedure.However,two patients suffered from the clinical features of delayed cardiac tamponade on the third-day post treatment,which was confirmed by US and CT.Finally,a pericardial effusion was drained,leading to dramatic improvement in the cardiovascular status of the patients.Conclusion Endovascular revascularization with pull-through technique for CVOD is a safe and practical method,with crucial route support for the success of endovascular therapies.