B超引导下经皮血管腔内血管成形术治疗自体动静脉内瘘狭窄12例

发布时间：2019-05-29 03:22

【摘要】：目的探讨B超引导下经皮血管腔内血管成形术(percutaneous transluminal angioplasty,PTA)治疗自体动静脉内瘘狭窄的临床体会。方法 2012年4月至2015年4月我院收治维持性血液透析自体动静脉内瘘狭窄致内瘘失功患者12例,B超引导下行PTA,对比手术前后狭窄部位血管直径、透析时血流量变化,定期随访观察动静脉内瘘远期通畅率。结果 12例内瘘失功患者B超检查发现狭窄部位在吻合口及其附近5例,在内瘘静脉透析用穿刺段7例。B超引导下在狭窄部位近心端8 cm处穿刺行PTA,术后B超显示11例血管再通,狭窄30%,透析中血流量良好;1例术后透析中血流量间断200 mL/min,静脉压高,血管造影显示上腔静脉狭窄,改为CT血管成像下行PTA。术后随访6个月,11例患者内瘘血流量满足透析所需;1例患者术后3个月再次出现血流量下降,B超显示狭窄部位有纤维环形成,再次行B超引导下PTA治疗,术后透析时血流量250 mL/min。结论 B超引导PTA无需特殊设备和场地,操作简单,适合内瘘失功处理要求快的特点,同时避免造影剂应用和放射线暴露损伤,具有较好疗效,可作为外周放射介入的替代治疗方法。
[Abstract]:Objective to investigate the clinical experience of ultrasound-guided percutaneous endovascular angioplasty (percutaneous transluminal angioplasty,PTA) in the treatment of autologous arteriovenous fistula stenosis. Methods from April 2012 to April 2015, 12 patients with failure of internal fistula caused by autologous arteriovenous fistula stenosis were treated in our hospital. PTA, guided by B ultrasound was used to compare the diameter of blood vessels and the changes of blood flow during dialysis. The long-term patency rate of arteriovenous fistula was observed at regular follow-up. Results in 12 patients with internal fistula failure, 5 cases of anastomotic site and 7 cases of puncture segment with intravenous dialysis of internal fistula were found by B-ultrasound. PTA, was punctured at 8 cm near the stenosis site under the guidance of B-ultrasound. Postoperative B-ultrasound showed recanalization in 11 cases, stenosis in 30%, and good blood flow during dialysis. One case had intermittent 200 mL/min, venous pressure during postoperative dialysis. angiography showed stenosis of superior vena cava and PTA. was performed by CT angiography. Follow-up for 6 months showed that the blood flow of internal fistula in 11 patients met the needs of dialysis. Blood flow decreased again in 1 patient 3 months after operation. B-ultrasound showed the formation of fiber ring in the narrow site. PTA was treated again under the guidance of B-ultrasound. The blood flow was 250 mL/min. during postoperative dialysis. Conclusion PTA guided by B ultrasound does not need special equipment and site, the operation is simple, and it is suitable for the rapid treatment of internal fistula power loss. At the same time, it avoids the application of contrast agent and radiation exposure injury, and has good curative effect. It can be used as an alternative therapy for peripheral radiation intervention.
【作者单位】：贵阳中医学院第二附属医院肾内科;
【分类号】：R459.5

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