人工血管动静脉内瘘中远期并发症的处理  

M anagement of the mid- and long-term complications of arteriovenous graft

作　　者：刘池拽[1] 胡锡祥[1] 缪健航[1] 师天雄[1] 

机构地区：[1]中山市人民医院中山大学附属中山医院血管外科,广东中山528400

出　　处：《中国血管外科杂志（电子版）》2016年第4期279-281,295,共4页Chinese Journal of Vascular Surgery(Electronic Version)

摘　　要：目的总结人工血管动静脉内瘘中远期并发症的处理经验。方法分析2009年1月至2014年12月本科65例（71例次）上肢人工血管动静脉内瘘术随访病例资料。结果本组病例失访14例,死亡9例。余42例随访时间为6~66个月,一期内瘘通畅时间1~51个月,平均15.6个月。随访期间内,38例出现内瘘堵塞或流量不足,其中30例患者行人工血管切开取栓术,手术成功率86.7%（26/30）,8例患者行经皮腔内血管成形术（PTA）。12例假性动脉瘤形成,其中1例未处理,2例行假性动脉瘤切除＋人工血管修补术,3例行假性动脉瘤切除＋血管吻合＋皮瓣转移修复术,6例行假性动脉瘤切除＋血管吻合术。1例反复穿刺部位的人工血管失功,1例动脉吻合口严重狭窄,均予以再次造瘘。3例发生人工血管感染,均行人工血管取出术。结论人工血管动静脉内瘘中远期的并发症主要为内瘘堵塞和假性动脉瘤形成,利用手术和介入的方法可处理人工血管的并发症,加强术后随访,早期干预可提高人工血管动静脉内瘘通畅率。Objective To summarize the experience in treatment of the mid- and long - term complications of arteriovenous graft. Method The data of 65 patients receiving arteriovenous graft from January 2009 to December 2014 were analyzed. Results Fifty-one patients were followed up, 14 were lost to follow-up, and 9 patients died. During the follow-up of 6~66 months, primary patency time was 1~51 months （mean 15.6 months）. There were 38 patients with graft occlusion or stenosis, and surgical thrombectomy was required for 30 patients with graft thrombosis, with a surgical success rate of 86.7% （26/30）. Percutaneous transluminal angioplasty （PTA） was performed on 8 patients. There were 12 pseudoaneurysms, 1 remained untreated, while 2 were treated with pseudoaneurysm resection and artificial vascular repair, 3 with pseudoaneurysm resection ＋ vascular anastomosis ＋ skin flap transfer, and 6 with pseudoaneurysm resection and vascular anastomosis. Graft infection occurred in 3 patients, and excision of the graft was performed on all of them. Conclusion The main mid- and long- term complications of arteriovenous graft are graft occlusion and pseudoaneurysm. The management involves surgery and PTA. Regular postoperative follow-up and early intervention may improve the patency of arteriovenous graft.

关 键 词：人工血管动静脉内瘘 并发症 手术 经皮血管腔内血管成形术 

分 类 号：R459.5[医药卫生—治疗学]