切割球囊治疗常规球囊扩张失败的动静脉内瘘狭窄  

Cutting balloon angioplasty in hemodialysis arteriovenous fistula stenosis resistant to conventional balloon angioplasty

作　　者：熊晓玲[1] 冯剑[1] 陆明晰[1] 胡卫民[1] 奚炜炜[1] 祝成[1] 张熙熙[1] 张树超[1] 陈昊路 叶有新[1] 李华[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院肾内科 血液透析血管通路中心 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》2015年第9期658-662,共5页Chinese Journal of Nephrology

基　　金：浙江省医药卫生科技计划项目（2012KYB106）

摘　　要：目的探讨常规球囊扩张失败的动静脉内瘘狭窄应用切割球囊治疗的临床疗效及安全性。方法前瞻性选取2011年12月至2015年2月常规球囊行经皮腔内血管成型术（percutaneous transluminal angioplasty，PTA）后残余狭窄〉30％的患者，切割球囊门A后每3个月复查。结果共25例患者，年龄（60．7±12．9）岁，其中自体动静脉内瘘（autogenous arteriovenous fistulas，AVF）11例，移植物内瘘（arterio-venous graft，AVG）14例。切割球囊PTA共30例次，技术成功率86．7％，临床成功率100％。治疗前后血管内径分别为（1．7±0．6）mm和（4．5±0．8）mm（P〈0．05）。6例患者存在多处狭窄。静脉流出道狭窄21例；静脉吻合口狭窄6例；头静脉弓狭窄6例；动脉狭窄2例；人造血管穿刺点狭窄1例。AVF组首次开通率为3个月70．0％，6个月10．0％；AVG组首次开通率为3个月64．3％，6个月7．1％（P〉0．05）。AVF组再次开通率为3个月70．0％，6个月30．0％；AVG组再次开通率3个月85．7％，6个月64．3％（P〉0．05）。术后随访时间（8．1±7．3）个月，再狭窄率为64．0％。4例次切割球囊PTA后残余狭窄〉30％，2例植入覆膜支架，2例应用超高压球囊PTA均达到技术成功。内瘘中位生存时间为173d。结论常规球囊扩张失败的严重钙化病变及“球囊腰”病变，切割球囊治疗的近期疗效及安全性值得肯定，经过反复的PTA可维持内瘘远期通畅，但不推荐替代常规球囊而作为一线治疗。切割球囊在AVF和AVG狭窄中的疗效优劣，以及其与高压球囊在效价方面的比较有待大样本、前瞻性、对照研究的结果。Objective To investigate the efficacy and safety of cutting balloon angioplasty for the treatment of hemodialysis arteriovenous fistula stenosis resistant to conventional percutaneous transluminal angioplasty （PTA）. Methods The patients with arteriovenous fistula stenosis who had suboptimal results （residual stenosis 〉 30%） by conventional PTA from December 2011 to February 2015 were enrolled. All the patients received cutting balloon angioplasty were rechecked every three months. Results A total of 25 patients with age of （60.7 ± 12.9） years had suboptimal PTA results. Eleven patients with native arteriovenous fistula （AVF） and 14 patients with graft fistula （AVG） underwent cutting PTA for 30 times. The technical success rate was 86.7% and clinical success rate was 100%. The diameter stenosis pre-procedural and post-procedural of cutting PTA was （1.7±0.6） mm and （4.5±0.8） mm respectively （P 〈 0.05）. Six patients had multiple lesions and the stenosis consisted of 21 outflow venous, 6 graft- to- vein anastomosis, 6 cephalic arch, 2 artery and 1 puncture hole stenosis. The primary access patency at 3 and 6 months for AVF group were 70.0% and 10.0%, while for AVG group the figures were 64.3% and 7.1% （P 〉 0.05）. The secondary access pateucy at 3 and 6 months for AVF group were 70.0% and 30.0%, while for AVG group the figures were 85.7% and 64.3% （P 〉 0.05）. The follow-up time was （8.1±7.3） months. The restenosis rate was 64.0%. Cutting PTA failed to achieve technical success for four times, of whom 2 patients required graft stent implantation and 2 patients required ultra- high- pressure balloons angioplasty to finally achieve technical success. The median survival time of fistula was 173 days. Conclusions Cutting balloon angioplasty have well short- term patency and safety in arteriovenous fistula stenosis resistant to conventional PTA, especially for calcified lesion or ＂balloon waist＂. Although it could provide a satisfied long patency by recurrent PTA,

关 键 词：动静脉瘘 缩窄 病理性 经皮腔内血管成型术 切割球囊 

分 类 号：R541.4[医药卫生—心血管疾病]