超声引导下经皮腔内血管成形术治疗人工血管动静脉内瘘狭窄:单中心36例病人通畅率分析

Ultrasound-guided percutaneous endovascular angioplasty in the treatment of arteriovenous graft stenosis:analysis of patency rate in 36 patients at a single center

目的:探讨超声引导下经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)治疗人工血管动静脉内瘘(arteriovenous graft,AVG)狭窄的有效性和可行性,分析PTA术后通畅率的影响因素。方法:回顾性分析36例维持性血液透析病人AVG发生狭窄采用PTA治疗前后内瘘狭窄处内径、透析血流量,肱动脉血流量变化,评估治疗效果。术后每3个月定期复查通畅情况。结果:36例病人手术均成功,术前36例病人狭窄处内径(1.58±0.35)mm,透析血流量(144.13±19.12)mL/min,肱动脉血流量(352.30±42.01)mL/min;PTA术后狭窄处内径(3.71±0.62)mm,透析血流量(275.75±14.29)mL/min,肱动脉血流量(616.83±45.92)mL/min,差异均有统计学意义(P<0.01),治疗有效。术后随访3、6、9、12个月,初级和次级通畅率分别为80.6%、66.7%、47.2%、38.9%和88.9%、75.0%、69.4%、58.3%。各随访时间初级通畅率和次级通畅率差异均无统计学意义(P>0.05)。病人术后1年通畅组的年龄低于非通畅组,差异有统计学意义(P<0.01)。结论:超声引导下PTA是治疗人AVG狭窄的有效方法,且年龄越大,术后通畅率越低。

Objective:To investigate the effectiveness and feasibility of ultrasound-guided percutaneous transluminal angioplasty(PTA)in the treatment of arteriovenous graft(AVG)stenosis,and analyze the influencing factors of patency rate after PTA.Methods:The inner diameter of stenosis,hemodialysis blood flow,brachial artery blood flow changes in 36 maintenance hemodialysis patients with AVG stenosis before and after PTA were retrospectively analyzed,and the therapeutic effects were evaluated.The patency rate was detected every 3 months after surgery.Results:All 36 patients were successfully operated.Before the treatment of PTA,the diameter of stenosis,AVG blood flow and brachial artery blood flow were(1.58±0.35)mm,(144.13±19.12)mL/min and(352.30±42.01)mL/min,respectively.After the treatment of PTA,the diameter of stenosis,AVG blood flow and brachial artery blood flow were(3.71±0.62)mm,(275.75±14.29)mL/min and(616.83±45.92)mL/min,respectively.The differences of the diameter of stenosis,AVG blood flow and brachial artery blood flow between before and after treatment were statistically significant(P<0.01),and which indicated that the treatment was effective.The patients were followed up for 3,6,9 and 12 months,and the primary patency and secondary patency rates were 80.6%,66.7%,47.2%and 38.9%,and 88.9%,75.0%,69.4%and 58.3%at each time-point,respectively.There was no statistical significance at each follow-up time between primary patency rate and secondary patency rate(P>0.05).The age of patients with postoperative 1 year patency was lower than that of patients with postoperative 1 year non-patency(P<0.01).Conclusions:The PTA guided by ultrasound is an effective method in the treatment of AVG stenosis,and the older the patient is,the lower the postoperative patency rate is.