28例自体动静脉内瘘狭窄闭塞腔内治疗的疗效分析

Analysis of clinical effect of endovascular treatment for stenosed or occluded arteriovenous fistula:a report of 28 cases

目的探讨自体动静脉内瘘(AVF)狭窄闭塞腔内治疗的有效性和安全性。方法收集2013年1月至2014年6月本中心经皮腔内血管成形术治疗的自体AVF狭窄闭塞病例,统计分析狭窄闭塞段数目、位置及相应治疗方式,术后即时、6个月、12个月通畅率及并发症。结果共28例患者,2例腔内治疗导丝无法通过病变段而失败,其中吻合口严重成角及内瘘闭塞严重各1例;其余26例患者共38处狭窄闭塞均先采用普通和或高压球囊扩张,4例患者头臂静脉球囊扩张后植入支架。介入治疗即时开通25例,成功率89.3%,并发症发生率7.1%(外渗及血栓形成各1例);治疗后6个月通畅率85.7%(24/28),12个月通畅率78.6%(22/28)。结论自体AVF狭窄闭塞类型多,治疗应个体化,经腔内治疗即时、6、12个月通畅率高,值得推广。

Objective To investigate the efficacy and safety of percutaneous transluminal angioplasty(PTA)for the treatment of arteriovenous fistula(AVF)stenosis or occlusion.Methods Positions and numbers of AVF stenosis or occlusion,operation procedure and immediate,6-and 12-month patency rate were recorded for the cases of AVF stenosis in our department for treatment of PTA from January 2013 to June2014.Results Twenty-eight cases of AVF stenosis or occlusion were enrolled.Two cases failed for PTA due to the guidewire could not go through the occlusive vascular.26 cases(including 38 stenosis or occlusion positions)were performed PTA.Immediate patency rate were 89.3%(25/28).The complication rate was7.1%,with one hemorrhage and one severe reperfusion injury.6-and 12-month patency rate was 85.7%and 78.6%,respectively.Conclusion PTA is an effective treatment method for AVF stenosis or occlusion,which has high rates of technical success,less complication and retain vascular resource.