肾透析患者桡动脉-头静脉人工造瘘通道阻塞的溶栓再通术

Thrombolytic recanalization in the treatment of obstruction of radial artery-cephalic vein artificial fistula in dialytic patients

目的 :探讨血液透析患者自体血管瘘道 (桡动脉与头静脉侧端吻合 )阻塞后用SP微导管的同轴导管技术微创的处理方法。方法 :总结 5例内瘘闭塞的肾透析患者 ,行血管造影诊断及介入溶栓治疗。其中 4例右侧、1例左侧桡动脉 头静脉人工造瘘堵塞 ,经皮右股动脉或肱动脉穿刺插管 ,送入headhunt经左或右锁骨下动脉至人工造瘘的桡动脉阻塞端 ,再送入SP微导管进行血栓溶栓术及导丝穿刺血栓松解术。全过程 2～ 4h ,实际溶栓时间 5 0min～ 2h。结果 :4例患者再通术成功 ,1例因狭窄而未通 ,无严重并发症发生。结论 :采用SP微导管的同轴导管技术行肾透析患者的桡动脉 肘正中静脉人工内瘘阻塞的溶栓及血栓松解术简便、安全。

Objective:To investigate the treatment of obstruction of autologous vascular fistula using microinvasive procedure with coaxial catheter of SP microcatheter.Methods:Interventional thrombolysis was performed in 5 cases of dialytic patients with obstruction of internal fistula,which was radial artery and cephalic vein end side anastomosis and included 4 cases on the right side and 1 on the left.The procedure of thrombolysis was as follows.The handhunt was inserted via the right femoral or brachial artery passing through the subclavicular artery to the obstructed end of the radial artery .Then,thrombolysis by agents and thrombus dissolution by puncturing with guidewire were performed.The whole procedure lasted for 2～ 4hrs.The actual times of thrombolysis were 50min～2hrs.Results:Recanalization was successful in 4 cases and failed in one due to presence of stenosis.No serious complication occurred. Conclusion: Thrombolysis and thrombus dissolution using coaxial catheter of SP microcatheter proves to be a microinvasive,simple,safe and effective method in the treatment of obstruction of artificial intramural fistula, that is radial artery cephalic vein in dialytic patients.