Application of ultrasound guided percutaneous transluminal angioplasty on arteriovenous fistula stenosis in hemodialysis patients
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摘要:
目的 探讨维持血液透析患者自体动静脉内瘘狭窄行经皮腔内血管成形术的应用。 方法 对2018年1月~2019年12月在本院进行血液透析并发动静脉内瘘狭窄的40例患者的临床资料进行回顾性分析，所有患者均在术前采用超声评估血管，术中采用超声指导经皮腔内血管成形术治疗，统计手术技术成功率、临床成功率、并发症发生情况，比较手术前后患者的血流指标。 结果 介入超声可清晰显示狭窄部位，引导内瘘狭窄行球囊扩张手术进程。经皮腔内血管成形术后彩超显示40例患者血管狭窄及血栓消失，治疗技术成功率100%，临床成功率100%。仅2例患者出现穿刺点皮下轻度血肿，所有患者均无严重并发症发生。术后动静脉内瘘狭窄处内径、透析血流量、内瘘血流量均较术前明显增加（P < 0.05）。 结论 超声引导下内瘘狭窄行腔内血管成形术具有较高的成功率及开通率，可作为一种安全有效的引导方法，具有一定的临床应用价值。 Abstract:Objective To investigate the application of ultrasound guided percutaneous transluminal angioplasty on arteriovenous fistula stenosis in maintenance hemodialysis patients. Methods The clinical data of 40 maintenance hemodialysis patients with arteriovenous fistula stenosis in our hospital from January 2018 to December 2019 were retrospectively analyzed. All patients accepted blood vessels assessment by ultrasound before operation, and underwent percutaneous transluminal angioplasty under ultrasound intervention guidance during operation. The technical success rate, clinical success rate and occurrence of complications were recorded, and the blood flow parameters before and after operation were compared. Results Ultrasound could clearly display the stenosis location, and guide the process of balloon dilatation for arteriovenous fistula stenosis. After percutaneous transluminal angioplasty, the color ultrasound showed that the stenosis and thrombosis disappeared in 40 patients, and both the technical success rate and clinical success rate were 100%. Only 2 cases had mild subcutaneous hematoma at the puncture site, and no serious complications occurred in all patients. The vessel diamete, hemodialysis blood flow and internal fistula blood flow of patients after operation were significantly higher than those before operation (P < 0.05). Conclusion Ultrasound guided percutaneous transluminal angioplasty has high success rate and vascular patency rate for arteriovenous fistula stenosis. Ultrasound can be used as a safe and effective guidance method, and is of certain clinical application value. -
Key words:
- hemodialysis /
- ultrasound /
- arteriovenous fistula /
- stenosis /
- percutaneous transluminal angioplasty
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图 1 超声介入下自体AVF狭窄的治疗
A: 标记血管位置及相应狭窄位置; B: 超声显示狭窄部位，测量狭窄血管直径; C: 彩超显示狭窄部位五彩血流信号; D: 近心端置入血管鞘，沿鞘进入泥鳅导丝; E: 观察并调整导丝穿过狭窄部位, 确认导丝进入桡动脉; F: 沿导丝进入球囊, 超声下球囊形态; G: 球囊在狭窄处进行扩张, 可见明显“束腰”样形态; H: 球囊打开扩张狭窄部位; I: 狭窄部位扩张后血流信号流畅, 血管直径明显增大.
Figure 1. Ultrasound guided treatment for arteriovenous fistula stenosis.
表 1 手术前后患者血管内径、透析血流量、内瘘血流量比较
Table 1. Comparison of vessel diamete, hemodialysis blood flow and internal fistula blood flow of patients before and after operation (n=40, Mean±SD)
组别 血管内径（mm） 内瘘血流量（mL/min） 透析血流量（mL/min） 术前 1.98±0.47 335.7±186.9 142.5±49.7 术后 4.76±0.69* 694.5±201.6* 251.6±36.9* *P < 0.05 vs术前. 
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