两种入路治疗动静脉内瘘狭窄或闭塞的效果比较
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摘要
目的研究超声引导下经桡动脉远心端入路以及头静脉近心端逆血流入路2种不同的穿刺方式治疗自体动静脉内瘘(arteriovenous fistula,AVF)狭窄或闭塞的有效性及安全性。方法选择2016年8月至2017年11月于成都市第五人民医院和成都市第一人民医院拟行超声引导下经皮血管腔内成形术(perctuaneous transluminal angioplasty,PTA)的AVF狭窄或闭塞患者63例。在治疗过程中,按分配床位单、双数,将患者分为2组,采取不同的穿刺入路方式,即超声引导下经桡动脉远心端入路(动脉组)和头静脉近心端逆血流入路(静脉组)对患者进行手术,比较两组的穿刺成功率、并发症发生情况,并随访一年内的一期通畅率。结果动脉组患者手术并发症发生率(21.88%)高于静脉组(9.68%),但两组比较差异无统计学意义(P>0.05)。动脉组导丝通过率(100.00%)与静脉组(83.87%)相当,差异无统计学意义(P>0.05)。动脉组患者PTA术后第3、6、9、12个月一期通畅率分别为100.00%、83.87%、77.42%、70.97%,静脉组分别为100.00%、80.77%、76.92%、73.07%,两组间一期通畅率差异无统计学意义(P>0.05)。结论超声引导下桡动脉远心端穿刺入路治疗AVF狭窄或者闭塞的导丝通过率高,术后通畅率尚可,可作为PTA治疗AVF狭窄或闭塞的重要入路。
Objective To study the effectiveness and safety of the two different puncture ways of ultrasound guided distal radial artery access and proximal reversal head vein flow access for the treatment of autogenous arteriovenous fistula(AVF) stenosis or occlusion. Methods Sixty-three patients with AVF stenosis or occlusion, undergoing perctuaneous transluminal angioplasty(PTA) under the guidance of ultrasound in Chengdu Fifth People's Hospital and Chengdu Fist People's Hospital from August 2016 to November 2017, were selected. In the course of treatment, patients were divided into two groups according to the allocation of the single and even numbers of hospital beds. Different puncture ways that is, ultrasound guided distal radial artery access(artery group) and proximal reversal head vein flow access(vein group), were adopted to conduct the surgery for the patients. The success rate, complications and phase 1 patency rate within 1 year in the two groups were calculated and compared. Results The incidence of complications(21.88%) in arterial group was higher than that in the vein group(9.68%), but comparison between the two groups showed no statistically significant difference(P>0.05). The guide wire overpass rate in the artery group was comparable to that in the vein group. There were no significant difference between the two groups(both P>0.05). The phase 1 overpass rates at the 3~(th), 6~(th), 9~(th) and 12~(th) months after the surgery were 100.0%, 83.87%, 77.42% and 70.97% in the arterial group. They were 100.0%, 80.77%, 76.92%, 73.07%, respectively, in the vein group. There was no significant difference in the phase 1 patency rate between the two groups(P>0.05). Conclusions The ultrasound-guided distal radial artery access for treatment of AVF stenosis or occlusion may be used as an important access for PTA to treat AVF stenosis or occlusion, due to high guide wire overpass rate and good post-operative patency.
Objective To study the effectiveness and safety of the two different puncture ways of ultrasound guided distal radial artery access and proximal reversal head vein flow access for the treatment of autogenous arteriovenous fistula(AVF) stenosis or occlusion. Methods Sixty-three patients with AVF stenosis or occlusion, undergoing perctuaneous transluminal angioplasty(PTA) under the guidance of ultrasound in Chengdu Fifth People's Hospital and Chengdu Fist People's Hospital from August 2016 to November 2017, were selected. In the course of treatment, patients were divided into two groups according to the allocation of the single and even numbers of hospital beds. Different puncture ways that is, ultrasound guided distal radial artery access(artery group) and proximal reversal head vein flow access(vein group), were adopted to conduct the surgery for the patients. The success rate, complications and phase 1 patency rate within 1 year in the two groups were calculated and compared. Results The incidence of complications(21.88%) in arterial group was higher than that in the vein group(9.68%), but comparison between the two groups showed no statistically significant difference(P>0.05). The guide wire overpass rate in the artery group was comparable to that in the vein group. There were no significant difference between the two groups(both P>0.05). The phase 1 overpass rates at the 3~(th), 6~(th), 9~(th) and 12~(th) months after the surgery were 100.0%, 83.87%, 77.42% and 70.97% in the arterial group. They were 100.0%, 80.77%, 76.92%, 73.07%, respectively, in the vein group. There was no significant difference in the phase 1 patency rate between the two groups(P>0.05). Conclusions The ultrasound-guided distal radial artery access for treatment of AVF stenosis or occlusion may be used as an important access for PTA to treat AVF stenosis or occlusion, due to high guide wire overpass rate and good post-operative patency.
引文
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[10] Aruny JE,Lewis CA,Cardella JF,et al.Quality improvement guidelines for percutaneous management of the thrombosed or dysfunctional dialysis access[J].J Vasc Interv Radiol,2003,14(9 Pt 2):S247-S253.
[11] Alamdaran A,Nazemian F,Taheri H.Doppler ultrasound assessment of well-functioning native hemodialysis access:comparison with sufficient dialysis[J].Iran J Radiol,2008,5(1):101-105.
[12] Argyriou C,Schoretsanitis N,Georgakarakos EI,et al.Preemptive open surgical vs.endovascular repair for juxta-anastomotic stenoses of autogenous AV fistulae:a meta-analysis[J].J Vasc Access,2015,16(6):454-458.
[13] Treitl KM,Konig C,Reiser MF,et al.Complications of transbrachial arterial access for peripheral endovascular interventions[J].J Endovasc Ther,2015,22(1):63-70.
[14] Fokou M,Teyang A,Ashuntantang G,et al.Complications of arteriovenous fistula for hemodialysis:an 8-year study[J].Ann Vasc Surg,2012,26(5):680-684.
[15] Ming Z,Li W,Ding W,et al.The efficacy of percutaneous transluminal angioplasty for treatment the patients with arteriovenous fistula dysfunction[J].Int Angiol,2016,35(2):163-169
[16] Lin CC,Yang WC.Clinical factors affecting patency of arteriovenous fistula in hemodialysis patients[J].Acta Nephrologica,2014,28(8):1206-1209.
[2] National Kidney Foundation.III NKF-K.DOQI Clinical practice guidelines for vascular access:update 2000[J].Am J Kidney Dis,2001,37(1 Suppl 1):S137-S181
[3] Murakami M,Miyamoto M,Suemitsu K.Percutaneous transluminal angioplasty in Japan:five-center investigation[J].J Vasc Access,2015,16(Suppl 10):S38-S42.
[4] Duque JC,Tabbara M,Martinez L,et al.Dialysis arteriovenous fistula failure and angioplasty:intimal hyperplasia and other causes of access failure[J].Am J Kidney Dis,2016,69(1):147-151.
[5] 王玉柱,叶朝阳,金其庄.中国血液透析用血管通路专家共识(第1版)[J].中国血液净化,2014,13(8):549-558.
[6] Reinhold C,Haage P,Hollenbeck M,et al.Multidisciplinary management of vascular access for haemodialysis:from the preparation of the initial access to the treatment of stenosis and thrombosis[J].Vasa,2011,40(3):188-198.
[7] 孟一,王春燕,王朝晖,等.超声引导下球囊扩张在维持性血液透析患者动静脉内瘘狭窄的应用[J].医学影像学杂志,2018,28(4):122-125.
[8] Jeon EY,Cho YK,Cho SB,et al.Predicting factors for successful maturation of autogenoushaemodialysis fistulas after salvage percutaneous transluminal angioplasty in diabetic nephropathy:a study on follow-up doppler ultrasonography[J].Iran J Radiol,2016,13(1):e32559.
[9] Manninen HI,Kaukanen ET,Ik?heimo R,et al.Brachial arterial access:endovascular treatment of failing brescia-cimino hemodialysis fistulas-initial success and long-term resultsl[J].Radiology,2001,218(3):711-718.
[10] Aruny JE,Lewis CA,Cardella JF,et al.Quality improvement guidelines for percutaneous management of the thrombosed or dysfunctional dialysis access[J].J Vasc Interv Radiol,2003,14(9 Pt 2):S247-S253.
[11] Alamdaran A,Nazemian F,Taheri H.Doppler ultrasound assessment of well-functioning native hemodialysis access:comparison with sufficient dialysis[J].Iran J Radiol,2008,5(1):101-105.
[12] Argyriou C,Schoretsanitis N,Georgakarakos EI,et al.Preemptive open surgical vs.endovascular repair for juxta-anastomotic stenoses of autogenous AV fistulae:a meta-analysis[J].J Vasc Access,2015,16(6):454-458.
[13] Treitl KM,Konig C,Reiser MF,et al.Complications of transbrachial arterial access for peripheral endovascular interventions[J].J Endovasc Ther,2015,22(1):63-70.
[14] Fokou M,Teyang A,Ashuntantang G,et al.Complications of arteriovenous fistula for hemodialysis:an 8-year study[J].Ann Vasc Surg,2012,26(5):680-684.
[15] Ming Z,Li W,Ding W,et al.The efficacy of percutaneous transluminal angioplasty for treatment the patients with arteriovenous fistula dysfunction[J].Int Angiol,2016,35(2):163-169
[16] Lin CC,Yang WC.Clinical factors affecting patency of arteriovenous fistula in hemodialysis patients[J].Acta Nephrologica,2014,28(8):1206-1209.