球囊扩张联合覆膜支架植入治疗人造血管动静脉内瘘狭窄  

Balloon angioplasty with covered-stent placement for arteriovenous graft stenosis

作　　者：熊晓玲[1] 叶有新[1] 李华[1] 冯剑[1] 胡卫民[1] 蒋欣欣[1] 陆明晰[1] 张树超[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院肾内科浙江大学邵逸夫临床医学研究所,杭州310016

出　　处：《中华肾脏病杂志》2013年第7期498-502,共5页Chinese Journal of Nephrology

基　　金：浙江省医药卫生科技计划项目（2012KYBl06）

摘　　要：目的探讨球囊扩张联合覆膜支架植入治疗人造血管动静脉内瘘（AVG）狭窄的临床疗效。方法前瞻性选取15例经皮腔内血管成型术（FTA）疗效欠佳的AVG狭窄患者，且具备以下特点：狭窄长度不超过7cm，狭窄程度大于50％；PTA后3个月内狭窄复发2次或以上；扩张后残余狭窄〉30％或狭窄部位立即弹性回缩。所有患者在数字减影血管造影（DSA）下行球囊扩张后植入不同内径的聚四氟乙烯覆膜支架。结果男3例，女12例，平均年龄（66±12）岁。支架植入前内瘘平均使用时间为（19．5±15．0）个月。共植人支架16枚，技术成功率100％，植入部位为静脉吻合口9例（9／15）；静脉流出道6例（6／15），其中头静脉3例，肱静脉2例，腋静脉1例。首次开通率3个月为40％，6个月为19％，12个月为13％。再次开通率3个月为93％，6个月为88％，12个月为87％。术后平均随访时间为（14．9±5．3）个月，再窄狭率为87％（13／15）。术后PTA36例次，支架内狭窄36％（13／36）；支架远端狭窄8％（3／36）；支架近端狭窄22％（8／36）；与支架无关的狭窄33％（12／36）。AVG中位生存时间为25个月。结论球囊扩张联合覆膜支架植入治疗AVG狭窄技术成功率高，并发症少，首次开通率不高，但再次开通率令人满意。Objective To investigate the clinical effectiveness of balloon angioplasty with covered- stent placement for arteriovenous graft stenosis. Methods A total of 15 patients with arteriovenous graft stenosis which all had poor therapeutic effect by percutaneous transluminal angioplasty （PTA） were enrolled. All the patients had either one or more stenotic lesion, which had below features： 7 cm or less in length and more stenosis （ 〉 50%）; stenosis recurred two or more times within 3 months after PTA; residual stenosis above 30% or elastic recoil immediately after expansion. Polytetrafluoroethylene-covered steuts with different diameter were placed after balloon angioplasty by digital subtraction angiography （DSA）. Results Patients were three men and twelve women with mean age （66± 12） years. The mean duration of arteriovenous graft was （19.5±15.0） months at the time of stent insertion. Total 16 stents were placed. The technical success rate was 100%. Nine patients （9/15） were vein-graft anastomosis stenosis and 6 patients （6/15） were outflow stenosis with 3 at cephalic vein, 2 at brachial vein and 1 at axillaIy vein. The primary access patency rates were 40% at 3 months, 19% at 6 months and 13% at 12 months. The secondary access patency rates were 93% at 3 months, 88% at6 months and 87ek at 12 monlhs. Tile mean follow-up time was （14.9±5.3） months. The restenosis rate was 87%（13/15）. IYFA was done 36 times after stenl plaeemen. The reasons fbr primary patency failure were in-stem stenosis 36e,4 （13/36）, intlow stenosis 8% （3/36）. ot,tflow stenosis 22% （8/36） and stenosis urn＇elated to stent placement 33% （12/36）. The median survival time of AVG was 25 months. Conclusion Balloon angioplasty with covered stent placement for arteriovenous graft stenosis has high rates of technieal suceess and less complication. The primalw access pateney is low but secondary access patency is satisfied.

关 键 词：血液透析 人造血管动静脉内瘘 狭窄 球囊扩张 覆膜支架 

分 类 号：R543[医药卫生—心血管疾病]