支架植入治疗血液透析动静脉瘘中心静脉阻塞的价值分析

发布时间：2018-04-26 23:12

本文选题：血液透析 + 自体动静脉内瘘　；参考：《介入放射学杂志》2017年08期

【摘要】：目的探讨经皮血管支架植入术(PTS)治疗自体动静脉内瘘(AVF)透析患者中心静脉阻塞(CVO)可行性及临床应用价值。方法回顾性分析10例AVF伴CVO患者,临床均表现为手肿胀综合征。术前或术中均接受DSA检查明确阻塞部位,根据不同病情采用合适手术入路,伴有血栓形成患者先行导管接触溶栓(CDT),严重狭窄或闭塞患者先以小直径球囊预扩张遂行PTS,其余患者直接行PTS。结果 DSA显示5例有颈内静脉置管史患者为头臂静脉闭塞或/和锁骨下静脉、颈内静脉、上腔静脉闭塞或狭窄,5例无颈内静脉置管史患者均表现为内瘘侧锁骨下静脉内侧段局限性严重狭窄。10例PTS技术成功率为100%,植入支架19枚,1例(锁骨下静脉狭窄)术后7个月支架内再狭窄再行PTS术。一期通畅率在术后6个月为8/8,术后1年为3/4。结论 AVF透析患者CVO多为闭塞性或严重狭窄病变,PTS治疗成功率高、近中期效果满意、并发症轻微,安全有效、可行,可作为首选治疗方法。
[Abstract]:Objective to investigate the feasibility and clinical value of percutaneous transluminal stent implantation (PTSs) in the treatment of central vein occlusion (CVOO) in patients with AVF. Methods Ten cases of AVF with CVO were retrospectively analyzed. Preoperative or intraoperative DSA examination was performed to determine the location of obstruction, and appropriate operative approaches were adopted according to different conditions. Patients with thrombus were treated with catheter contact thrombolytic thrombolytic thrombolysis (CDT). The patients with severe stenosis or occlusion were performed PTSs with small diameter balloon dilatation first, and the others with PTSs directly. Results DSA showed that 5 patients with history of internal jugular vein catheterization were occluded or / or subclavian vein and internal jugular vein. 5 cases of superior vena cava occlusion or stenosis without history of internal jugular vein indwelling showed severe local stenosis of medial segment of subclavian vein of internal fistula. Success rate of PTS technique was 100%, and 19 stents were implanted in 1 case (subclavian vein stenosis). PTS was performed 7 months after stent restenosis. The primary patency rate was 8 / 8 at 6 months and 3 / 4 at 1 year. Conclusion CVO in AVF dialysis patients with occlusive or severe stenosis has a high success rate, satisfactory results in the near and middle stage, mild complications, safety and effectiveness, and can be used as the first choice for the treatment.
【作者单位】：上海交通大学医学院附属苏州九龙医院介入血管外科;
【分类号】：R692.5

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