经皮球囊扩张成形术治疗慢性人工血管动静脉内瘘闭塞
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摘要
目的观察经皮球囊扩张成形术(percutaneous transluminal angioplasty,PTA)治疗慢性人工血管动静脉内瘘(arteriovenous graft,AVG)闭塞疗效。方法回顾性分析四川大学华西医院2017年1月～2018年1月因AVG闭塞行PTA治疗的维持性血液透析患者18例,分析技术成功率、通畅率、病变特点、并发症。结果本研究共纳入18例患者,內瘘闭塞时间10.5(3,14)天。静脉吻合口狭窄12例,静脉流出道狭窄7例,其中狭窄≥2处者6例,技术成功率94.4%,并发症发生率5.6%,1个月、3个月、6个月及1年初级通畅率分别是72.2%、66.7%、55.6%和33.3%,次级通畅率分别是88.9%、83.3%、77.8%和50%。结论 PTA治疗慢性AVG闭塞有效、安全、微创,延长了AVG使用时间。
Objective To observe the curative effect of percutaneous transluminal angioplasty(PTA) for the treatment of chronic thrombosed arteriovenous graft(AVG).Methods A retrospective analysis was performed on 18 maintenance hemodialysis patients who underwent PTA for the treatment of chronic thrombosed AVG in West China Hospital of Sichuan University from January 2017 to January 2018.The technical success rate,patency rate,pathological feature and complication of the procedure at different intervals were analyzed.Results A total of 18 patients were enrolled in the study.The occlusion of AVG lasted for 10.5(3,14) days.There were 12 cases of venous anastomotic stenosis,7 cases of venous outflow stenosis,6 cases had more than 2 stenotic lesions.The technical success rate of the procedure was 94.4% and complication rate was5.6%.Primary patency after one month,3 months,6 months and one year were 72.2%,66.7%,55.6% and33.3% respectively,and secondary patency rates after the same intervals were 88.9%,83.3%,77.8% and 50%respectively.Conclusion PTA is an effective,safe,minimally invasive method for the treatment of chronic thrombosed AVG,with no requirement for the occlusion time.This method prolongs the survival time of arteriovenous graft.
Objective To observe the curative effect of percutaneous transluminal angioplasty(PTA) for the treatment of chronic thrombosed arteriovenous graft(AVG).Methods A retrospective analysis was performed on 18 maintenance hemodialysis patients who underwent PTA for the treatment of chronic thrombosed AVG in West China Hospital of Sichuan University from January 2017 to January 2018.The technical success rate,patency rate,pathological feature and complication of the procedure at different intervals were analyzed.Results A total of 18 patients were enrolled in the study.The occlusion of AVG lasted for 10.5(3,14) days.There were 12 cases of venous anastomotic stenosis,7 cases of venous outflow stenosis,6 cases had more than 2 stenotic lesions.The technical success rate of the procedure was 94.4% and complication rate was5.6%.Primary patency after one month,3 months,6 months and one year were 72.2%,66.7%,55.6% and33.3% respectively,and secondary patency rates after the same intervals were 88.9%,83.3%,77.8% and 50%respectively.Conclusion PTA is an effective,safe,minimally invasive method for the treatment of chronic thrombosed AVG,with no requirement for the occlusion time.This method prolongs the survival time of arteriovenous graft.
引文
[1]中国医院协会血液净化中心管理分会血液净化通路学组.中国血液透析用血管通路专家共识(第1版)[J].中国血液净化杂志,2014,13(8):549-558.
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[6]詹申,张丽红,王玉柱,等.超声技术辅助人造血管动静脉内瘘血栓的腔内治疗[J].中国血液净化,2018,17(04):272-276.
[7]Bermudez P,FontseréN,Mestres G,et al.Endovascular revascularization of hemodialysis thrombosed grafts with the hydrodynamic thrombectomy catheter.our 7-year experience[J].Cardiovascu Intervent Radiol,2017,40(2):252-259.
[2]Schwab S,Besarab A,Beathard G,et al.NKF-DOQI clinical practice guidelines for vascular access[J].Am JKidney Dis,1997,30(4):S150-S191.
[3]Ota K,Tsuji Y,Kukita K,et al.Long-term outcome of Terumo vascular graft(GRASIL?)for hemodialysis[J].JJpn Soc Dial Ther,2006,39(9):1395-1401.
[4]尹杰,张宪生,佘康,等.人工血管透析通路闭塞的处理[J].中华临床医师杂志(电子版),2015,9(8):1312-1316.
[5]郭相江,赵意平,施娅雪,等.尿激酶溶栓治疗人工血管动静脉内瘘急性血栓形成[J].中国血液净化,2011,10(04):198-200.
[6]詹申,张丽红,王玉柱,等.超声技术辅助人造血管动静脉内瘘血栓的腔内治疗[J].中国血液净化,2018,17(04):272-276.
[7]Bermudez P,FontseréN,Mestres G,et al.Endovascular revascularization of hemodialysis thrombosed grafts with the hydrodynamic thrombectomy catheter.our 7-year experience[J].Cardiovascu Intervent Radiol,2017,40(2):252-259.