经皮腔内血管成形术开通带隧道和涤纶套透析导管留置后失功中心静脉及再置管的意义  

Percutaneous transluminal angioplasty for dysfunctional central vein caused by tunnel-cuffed catheter

作　　者：卜泉东[1] 栾弘 牛立园 徐岩[1] 张岩[3] 王曰伟[2] BU Quandong;LUAN Hong;NIU Liyuan;XU Yan;ZHANG Yan;WANG Yuewei(Department of Nephrology,Affiliated Hospital of Qingdao University,Qingdao,Shandong Province 266003,China)

机构地区：[1]青岛大学附属医院肾内科,山东青岛266003 [2]青岛大学附属医院血管外科,山东青岛266003 [3]青岛大学附属医院介入手术室,山东青岛266003

出　　处：《介入放射学杂志》2024年第9期961-966,共6页Journal of Interventional Radiology

基　　金：山东省自然科学基金(ZR2020QH060);青岛大学附属医院“临床医学+X”科研项目(QDFY+X202101064)。

摘　　要：目的 探讨DSA造影下经皮腔内血管成形术(percutaneous transluminal angioplasty, PTA)开通带隧道和涤纶套的透析导管(tunnel-cuffed catheter, TCC)留置后失功中心静脉和再置管的意义。方法 纳入2018年7月至2022年7月在青岛大学附属医院肾内科就诊的TCC留置相关中心静脉病变患者13例。TCC留置中位时间35.2个月(6~70个月)。在加硬导丝支撑下拔除失功导管并造影显示中心静脉狭窄或闭塞。PTA开通中心静脉并原位或异位置入新TCC。结果 13例患者中有12例原TCC顺利拔除,1例因导管粘连严重,拔除失败。中心静脉狭窄包括右颈静脉、无名静脉、上腔静脉和右髂静脉,行PTA后均成功置入新TCC,未行支架植入。患者术后中位随访时间为23.1个月(6~48个月),通路功能正常。结论 DSA下PTA开通TCC相关中心静脉狭窄或闭塞,置入新TCC导管,能够为TCC后失功患者重新建立透析通路,延长通路寿命。Objective To investigate the clinical application of percutaneous transluminal angioplasty(PTA)in treating dysfunctional central vein caused by tunnel-cuffed catheter(TCC)under digital subtraction angiography(DSA)guidance.Methods A total of 13 patients with indwelling TCC-related central vein complications,who were admitted to the Department of Nephrology of the Affiliated Hospital of Qingdao University of China between July 2018 and July 2022,were enrolled in this study.The average indwelling duration of TCC was 35.2 months(range of 6-70 months).The dysfunctional TCC was removed with the help of a stiff guide wire,and angiography showed that the central vein was narrowed or occluded.PTA was performed to reopen the central vein,and a new TCC was placed in situ or in another site.Results Of the 13 patients,original TCC was successfully removed in 12,and failure of removal was seen in one.The site of central venous stenosis included the right jugular vein,innominate vein,superior vena cava,and right iliac vein,and successful placement of a new TCC was accomplished in all patients after PTA,and no stent implantation was employed.The average follow-up period was 23.1 months(range of 6-48 months),and the TCC functioned well.Conclusion Under DSA guidance,the recanalization of TCC-related central venous stenosis or occlusion by PTA and the implantation of a new TCC catheter can successfully establish a new dialysis access for patients with poorly functioning TCC,in this way the lifespan of the pathway can be extended.

关 键 词：经皮腔内血管成形术 中心静脉狭窄 带隧道和涤纶套的透析导管 血液透析 数字减影血管造影 

分 类 号：R659[医药卫生—外科学]