介入导管技术在动静脉内瘘失功治疗中的应用
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张学民, Email: zhangxuemin128@126.com

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Application of interventional catheterization procedure in arteriovenous fistula dysfunction
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    摘要:

    目的:探讨动静脉内瘘(AVF)失功后介入手术的治疗方法,评估其治疗效果及应用价值。 方法:回顾性分析自2006年4月—2015年1月行介入手术治疗的20例自体AVF失功患者的临床资料。 结果:20例患者中,16例经静脉端造影,4例经股动脉-主动脉-腋动脉路径造影;单纯吻合口狭窄4例,行球囊扩张后狭窄明显改善;吻合口狭窄伴血栓形成有5例,切开取栓后再行球囊扩张治疗;静脉端血栓形成3例,切开取栓后返血良好;静脉端狭窄合并血栓形成7例,行切开取栓后再行球囊扩张治疗;头静脉长段闭塞1例,改用人工血管行AVF术。术后全部患者经该血管通路恢复透析治疗,透析时流量均>200 mL/min。共17例患者获得随访,平均随访时间13.2个月,12个月通畅率为47.1%。 结论:介入导管技术在治疗AVF失功方面是安全、有效的。

    Abstract:

    Objective: To investigate the interventional surgery for arteriovenous fistula (AVF) dysfunction and evaluate its therapeutic effect and application value. Methods: The clinical data of 20 patients with autogenous AVF dysfunction undergoing interventional treatment from April 2006 to January 2015 were retrospectively reviewed. Results: Among the 20 patients, 16 cases underwent angiography through venous approach, and 4 cases had angiography through femoral/aortic/axillary artery approach; 4 cases had simple anastomotic stenosis that was significantly improved by balloon dilatation, 5 cases had anastomotic stenosis with thrombosis, which was treated by balloon expansion after venous embolectomy; 3 cases had thrombosis at the venous anastomotic site, and good backflow was obtained after embolectomy; 7 cases with venous anastomotic stenosis and thrombosis underwent balloon angioplasty after venous embolectomy, and one case with long segment stenosis of the cephalic vein was treated by inserting a prosthetic arteriovenous graft. All patients restarted dialysis treatment using the original vascular access, with dialysis flow greater than 200 mL/min. Follow-up was obtained in 17 patients, with an average follow-up period of 13.2 months, and the 12-month patency rate was 47.1%. Conclusion: Interventional catheterization procedure is safe and effective in treatment of AVF dysfunction.

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贺致宾,张学民,张小明,蒋京军,焦洋,李清乐,何长顺.介入导管技术在动静脉内瘘失功治疗中的应用[J].中国普通外科杂志,2015,24(6):847-851.
DOI:10.3978/j. issn.1005-6947.2015.06.016

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  • 收稿日期:2015-03-09
  • 最后修改日期:2015-05-20
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  • 在线发布日期: 2015-06-15