超声下经皮血管成形术治疗人工血管内瘘狭窄的疗效  

Ultrasound-guided percutaneous transluminal angioplasty in treatment of arteriovenous graft stenosis

作　　者：杨世峰[1] 李大庆[1] 解立怡[1] 刘超[1] 路万虹[1] YANG Shifeng;LI Daqing;XIE Liyi;LIU Chao;LU Wanhong(Department of Nephrology ,First Affiliate Hospital of Xi'an Jiaotong University ,Xi'an710061,China)

机构地区：[1]西安交通大学第一附属医院肾脏内科,西安710061

出　　处：《肾脏病与透析肾移植杂志》2018年第6期533-537,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的:总结超声监视下经皮血管成形术(PTA)治疗人工血管内瘘(AVG)狭窄的效果。方法:回顾性分析超声监视下PTA术治疗AVG狭窄的112例患者的资料。结果:狭窄部位中静脉吻合口占61. 8%,动脉吻合口占13. 2%,人工血管穿刺点占15. 3%,引流静脉占8. 3%。68. 7%的患者为狭窄合并血栓形成,31. 3%为单纯狭窄。合并血栓患者的狭窄程度高于单纯狭窄患者(87. 1%±6. 2%vs 71. 0%±7. 4%,P<0. 05),而两组患者在狭窄部位的构成上无显著性差异。手术成功率96. 5%,球囊扩张技术成功率100%。>70%的狭窄需要用14 atm以上的扩张压力。PTA术后AVG的初级通畅率为6个月68. 8%±5. 0%和12个月25. 3%±4. 2%,次级通畅率为6个月98. 6%±1. 7%和12个月80. 2%±6. 3%。结论:AVG狭窄最常见的部位是静脉吻合口。狭窄是引起AVG血栓形成最主要的原因。AVG血栓形成与狭窄部位的关系不大,而主要取决于狭窄的程度。超声监视下PTA术是治疗AVG狭窄安全有效的方法。AVG的血流动力学决定了其特定部位好发狭窄和初级通畅率较低,但重复PTA治疗可获得较高的次级通畅率。Objective: To summarize the effect of ultrasound-guided percutaneous transluminal angioplasty( PTA)in treatment of arteriovenous graft( AVG) stenosis. Methodology: The clinical data of One hundred twelve patients with AVG stenosis treated by ultrasound-guided PTA were retrospectively analyzed. Results: Vein anastomosis occurred in61. 8%,while arterial anastomosis 13. 2%,artificial vascular puncture point 15. 3% and drainage vein 8. 3% of the total stenotic sites.68. 7% of the patients were stenosis accompanied thrombosis,while 31. 3% were stenosis only. The degree of vascular stenosis in patients with thrombosis was severer than that in patients with stenosis only( 87. 1%±6. 2% vs 71. 0%±7. 4%,P<0. 05).However,there was no significant difference in the composition of stenotic sites between these two groups.The success rate of operation was 96. 5%,and technical success rate of balloon dilation was 100%. More than 70% of the stenosis required dilatation pressure of at least 14 atm.The primary patency rate of AVG after PTA was 68. 8%±5. 0% in 6months and 25. 3%±4. 2% in 12 months,while the secondary patency rate was 98. 6% ± 1. 7% in 6 months and 80. 2% ±6. 3% in 12 months respectively. Conclusion: The most common site of AVG stenosis is venous anastomosis. Stenosis is the main cause of thrombosis in AVG,and reasonable management of stenosis is the key of preventing thrombosis.Thrombosis of AVG is not related to the location of stenosis,but depends mainly on the degree of stenosis.Ultrasound-guided PTA is a safe and effective treatment for AVG stenosis.The hemodynamics of AVG determines high incidence of stenosis in specific location and low primary patency rate,but higher secondary patency can be achieved by repeated PTA treatment.

关 键 词：人工血管内瘘 经皮血管成形术 超声 狭窄 

分 类 号：R692[医药卫生—泌尿科学]