超声引导下活检钳技术在内瘘闭塞中应用的可行性
|
摘要
目的探讨超声引导下活检钳咬取闭塞动-静脉内瘘(内瘘)中陈旧性血栓或附壁血栓的可行性及有效性。方法44例行维持性血液透析并内瘘闭塞患者,采用超声引导下活检钳技术取出切开或血管腔内抽吸无法清除的全部血栓,观察其成功率。结果 44例患者中40例成功钳取剩余血栓,成功率为90.91%;4例术前1周内瘘血栓形成、并伴穿刺部位瘤样扩张处附壁血栓形成患者,内瘘未能成功开通,后行对侧肢体自体动-静脉内瘘成形术;均未发生严重并发症。结论维持性血液透析并内瘘闭塞患者切开或血管腔内抽吸无法清除全部血栓时,利用活检钳取栓疗效确切,安全。
Objective To investigate the feasibility and efficacy of ultrasound-guided biopsy forceps on obliterating the old thrombus or mural thrombus in arteriovenous fistula occlusion.Methods Forty-four patients with arteriovenous fistula undergoing maintenance hemodialysis were performed ultrasound-guided biopsy forceps to obliterate all thrombus failed in surgery or percutaneous transluminal angioplasty.The success rate was observed.Results In 44 patients,40 patients(90.91%)were successfully obliterated by biopsy forceps,and the other 4 patients failed due to arteriovenous fistula occlusion and mural thrombus at the dilated puncture site formed one week before operation,which were treated by arteriovenous fistula plasty in the contralateral limb.No serious complications were found.Conclusion Biopsy forceps is effective and safe for patients with arteriovenous fistula occlusion and undergoing maintenance hemodialysis when the thrombus could not be removed by surgery or percutaneous transluminal angioplasty.
Objective To investigate the feasibility and efficacy of ultrasound-guided biopsy forceps on obliterating the old thrombus or mural thrombus in arteriovenous fistula occlusion.Methods Forty-four patients with arteriovenous fistula undergoing maintenance hemodialysis were performed ultrasound-guided biopsy forceps to obliterate all thrombus failed in surgery or percutaneous transluminal angioplasty.The success rate was observed.Results In 44 patients,40 patients(90.91%)were successfully obliterated by biopsy forceps,and the other 4 patients failed due to arteriovenous fistula occlusion and mural thrombus at the dilated puncture site formed one week before operation,which were treated by arteriovenous fistula plasty in the contralateral limb.No serious complications were found.Conclusion Biopsy forceps is effective and safe for patients with arteriovenous fistula occlusion and undergoing maintenance hemodialysis when the thrombus could not be removed by surgery or percutaneous transluminal angioplasty.
引文
[1]闫磊,张宏涛,朱清,等.透析患者动静脉内瘘超声引导下经皮腔内血管成形术后效果评估时机选择[J].中华实用诊断与治疗杂志,2017,31(8):777-778.
[2]STOLIC R.Most important chronic complications of arteriovenous fistulas for hemodialysis[J].Med Princ Pract,2012,22(3):220-228.
[3]DEMBER L M,IMREY P B,BECK G J,et al.Objectives and design of the hemodialysis fistula maturation study[J].Am JKidney Dis,2014,63(1):104-112.
[4]张丽红,王玉柱.超声引导下PTA在动静脉内瘘狭窄中的应用[J].中国血液净化,2016,15(6):321-323.
[5]胡亚立,赵辉俊,赵翼,等.置入支架治疗人工血管动静脉内瘘闭塞患者5例临床分析[J].中华实用诊断与治疗杂志,2014,28(11):1105-1106.
[6]赵梦鹏,韩新强,王文明,等.血液透析患者自体动静脉内瘘功能丧失的治疗进展[J].中国介入影响与治疗血,2017,14(11):703-706.
[7]叶朝阳,戴兵.动静脉内瘘血栓的诊断和处理[J].肾脏病与透析肾移植杂志,2013,22(4):141-142.
[8]SEQUEIRA A,NALJAYAN M,VACHHARAJANI T J.Vascular access guidelines:summary,rationale,and controversies[J].Tech Vasc Interv Radiol,2017,20(1):2-8.
[9]KIM S M,KO H K,NOH M,et al.Factors affecting patency following successful percutaneous intervention for dysfunctional hemodialysis vascular access[J].Ann Vasc Surg,2018,47(2):54-61.
[10]NIKAM M D,RITCHIE J,JAYANTI A,et al.Acute arteriovenous access failure:long-term outcomes of endovascular salvage and assessment of co-variates affecting patency[J].Nephron,2015,129(4):241-246.
[11]CHAN P G,GOH G S.Safety and efficacy of the AngioJet device in the treatment of thrombosed arteriovenous fistula and grafts:a systematic review[J].J Vasc Access,2018,19(3):243-251.
[2]STOLIC R.Most important chronic complications of arteriovenous fistulas for hemodialysis[J].Med Princ Pract,2012,22(3):220-228.
[3]DEMBER L M,IMREY P B,BECK G J,et al.Objectives and design of the hemodialysis fistula maturation study[J].Am JKidney Dis,2014,63(1):104-112.
[4]张丽红,王玉柱.超声引导下PTA在动静脉内瘘狭窄中的应用[J].中国血液净化,2016,15(6):321-323.
[5]胡亚立,赵辉俊,赵翼,等.置入支架治疗人工血管动静脉内瘘闭塞患者5例临床分析[J].中华实用诊断与治疗杂志,2014,28(11):1105-1106.
[6]赵梦鹏,韩新强,王文明,等.血液透析患者自体动静脉内瘘功能丧失的治疗进展[J].中国介入影响与治疗血,2017,14(11):703-706.
[7]叶朝阳,戴兵.动静脉内瘘血栓的诊断和处理[J].肾脏病与透析肾移植杂志,2013,22(4):141-142.
[8]SEQUEIRA A,NALJAYAN M,VACHHARAJANI T J.Vascular access guidelines:summary,rationale,and controversies[J].Tech Vasc Interv Radiol,2017,20(1):2-8.
[9]KIM S M,KO H K,NOH M,et al.Factors affecting patency following successful percutaneous intervention for dysfunctional hemodialysis vascular access[J].Ann Vasc Surg,2018,47(2):54-61.
[10]NIKAM M D,RITCHIE J,JAYANTI A,et al.Acute arteriovenous access failure:long-term outcomes of endovascular salvage and assessment of co-variates affecting patency[J].Nephron,2015,129(4):241-246.
[11]CHAN P G,GOH G S.Safety and efficacy of the AngioJet device in the treatment of thrombosed arteriovenous fistula and grafts:a systematic review[J].J Vasc Access,2018,19(3):243-251.