手术治疗动静脉内瘘动脉瘤中远期疗效分析

Mid-and long-term therapeutic efficacy of surgical treatment for arteriovenous fistula aneurysm

目的探讨不同手术方式行自体动静脉内瘘动脉瘤(arteriovenous fistula aneurysm,AVFa)切除后对内瘘功能的中远期影响。方法回顾性分析2016年2月─2020年2月于安徽医科大学第一附属医院血管外科手术治疗AVFa的患者,收集患者临床资料并随访36 m。结果36例入选患者中5例行AVFa切除术,18例患者行AVFa成形术,手术后即时经原动静脉内瘘(arteriovenous fistula,AVF)行穿刺透析,随访期间AVF功能正常、无AVFa复发。另其他手术方式辅助流出道重建术13位患者,随访36 m内5例出现AVF吻合口狭窄,经皮腔内血管扩张成形术(percutaneous transluminal angioplasty,PTA)治疗后AVF恢复通畅。结论动脉瘤成形术是治疗血液透析患者AVFa一种有效方法,能充分节约前臂血液透析的血管资源且中远期通畅率满意。

Objective To investigate the mid-and long-term effects of different surgical methods to resect arteriovenous fistula aneurysm(AVFa)on fistula function.Methods We retrospectively analyzed the clinical data of 36 patients undergoing surgical treatment of AVFa at our center between Feb.2016 and Feb.2020.Eighteen patients underwent aneurysmorrhaphy to reshape the new AVF,13 ineligible patients underwent aneurysm resection with outflow reconstruction to construct a new dialysis pathway,and 5 patients had only aneurysm resection and failed to retain fistula function.All patients were followed up for 36 months.Results The 18 patients undergoing aneurysmorrhaphy dialyzed with the primary AVF immediately after surgery,with normal AVF function and no recurrence of aneurysm in follow-up study.Of the 13 patients undergoing reconstruction of the outflow tract,5 had anastomotic stricture in the 36 months period of follow-up.The fistula became patent after PTA treatment and could be used normally.The remaining 5 patients underwent AVFa resection.Conclusion Aneurysmorrhaphy is an effective treatment for AVFa in hemodialysis patients,can preserve adequate vascular resources in forearm for hemodialysis,and has satisfactory mid-and long-term patency rates.