Fogarty球囊导管取栓对人造血管内瘘血栓形成疗效分析  

Fogarty balloon catheter embolectomy for arteriovenous graft thrombosis in hemodialysis patients: an analysis of outcomes

作　　者：张万君 梅兰 刘碧坚 王刚 刘会喜 蔡宇 贾晓丹 

机构地区：[1]解放军202医院血液净化科,沈阳110003

出　　处：《华西医学》2017年第2期182-185,共4页West China Medical Journal

摘　　要：目的探讨Fogarty球囊导管取栓术对维持性血液透析患者人造血管内瘘血栓形成的治疗效果。方法回顾性分析2010年3月—2014年11月行Fogarty球囊导管取栓术的11例维持性血液透析人造血管内瘘血栓形成患者的临床资料。在人造血管U形内瘘底部作横切口,选择4F或6F球囊导管由切口插入并越过血栓,向球囊内注入生理盐水,先后将静脉和动脉侧血栓拉出,开放血流,确认内瘘通畅。取栓后给予人造血管内瘘体检及超声检查。超声检查发现吻合口狭窄者进一步行CT血管造影术进行血管成像。结果 11例患者均顺利完成Fogarty球囊导管取栓术。其中3例因静脉吻合口狭窄行球囊扩张术,2例存在动脉吻合口狭窄给予手术重建。经采取相应措施处理后11例人造血管内瘘血栓取出,内瘘全部恢复通畅。术后第2~7天开始使用低分子肝素抗凝,疗程为1周,血液透析血流速度可达250 m L/min以上。术后随访4~30个月,5例患者取栓后人造血管内瘘持续应用;4例再次血栓形成,分别发生于取栓术后第2、3、25、71天;1例取栓成功后人造血管表面皮肤破溃感染不愈合,手术取出人造血管,改用腹膜透析;1例转外地维持透析,未再随访。11例患者的有效率为81.8%。结论 Fogarty球囊导管取栓术对血液透析患者已栓塞人造血管内瘘恢复通畅效果确切,有必要开展进一步的研究。Objective To evaluate the effect of Fogarty balloon catheter embolectomy on arteriovenous graft thrombosis in hemodialysis patients. Methods We retrospectively analyzed the clinical data of 11 patients who underwent maintaining hemodialysis and arteriovenous graft thrombosis through Fogarty balloon catheter embolectomy between March 2010 and November 2014. The thrombosed graft was incised, and a 4 or 6 French catheter was placed in the venous and arterial limbs of the graft respectively. The Fogarty balloon was passed beyond the thrombus and pulled out after saline was infused into the balloon, and the thrombus was taken out. The procedure was considered unsuccessful if the blood flow was not re-established or if the graft re-thrombosed within hours. Results The treatment was successfully performed in all the patients. Of the 11 patients, 3 received balloon dilation due to stenosis of venous anastomosis, and 2 received angioplasty due to underlying arterial anastomosis lesion. After corresponding measures were taken, the thrombus of all the 11 patients were taken out, and blood flow was recovered. Two to seven days after surgery,low molecular weight heparin was used for anti-coagulation. The blood flow of all arteriovenous grafts reached over250 m L/min. All the patients were followed up for 4 to 30 months. During the follow-up, the arteriovenous graft remained functional in 5 patients; 4 patients had re-thrombosis on day 2, 3, 25, and 71 after surgery respectively; one changed to undergo peritoneal dialysis due to rupture and infection of the graft, and one patient was transferred to another hospital in another area and was not followed up any longer. The therapy was successful in 81.8% of this group of patients.Conclusion Fogarty balloon catheter embolectomy is effective in restoring patency of thrombosed arteriovenous graft in hemodialysis patients, and more studies are needed.

关 键 词：FOGARTY球囊导管 血栓形成 人造血管内瘘 血液透析 

分 类 号：R459.5[医药卫生—治疗学]