比较直接或于超声引导下经皮腔内血管成形扩张桡动脉后及反“J”型移植物建立动静脉瘘用于接受血液透析而相应血管细小患者  

Comparison on direct and after ultrasound-guided percutaneous transluminal angioplasty of radial artery arteriovenous fistula formation and reverse“J”arteriovenous graft formation in hemodialysis patients with relative small diameter vessels

作　　者：姜燕 熊智倩 刘俪婷 苏朝江 陈彦 张帅 刘宗旸 JIANG Yan;XIONG Zhiqian;LIU Liting;SU Chaojiang;CHEN Yan;ZHANG Shuai;LIU Zongyang(Department of Nephrology,Affiliated Cancer Hospital of Guizhou Medical University,Guiyang 550003,China;School of Clinical Medicine,Guizhou Medical University,Guiyang 550004,China;Laboratory,Affiliated Cancer Hospital of Guizhou Medical University,Guiyang 550003,China)

机构地区：[1]贵州医科大学附属肿瘤医院肾内科,贵州贵阳550003 [2]贵州医科大学临床医学院,贵州贵阳550004 [3]贵州医科大学附属肿瘤医院实验室,贵州贵阳550003

出　　处：《中国介入影像与治疗学》2025年第3期159-163,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：北京健康促进会中国血液透析血管通路青年医师研究项目(MSXM002)。

摘　　要：目的比较直接或于超声引导下以经皮腔内血管成形(PTA)扩张桡动脉后建立动静脉瘘(AVF),以及利用反“J”型移植物建立移植物动静脉瘘(AVG)用于需要接受血液透析而相应血管细小患者的价值。方法回顾性纳入96例计划接受血液透析治疗而桡动脉远端直径<1.5 mm、头静脉直径≥2.0 mm的终末期肾病患者,根据造瘘方案将其分为AVF组(n=30)、PTA+AVF组(n=34)及AVG组(n=32);比较3组技术成功率、临床成功率、初级通畅率及次级通畅率。结果AVF组、PTA+AVF组及AVG组技术成功率分别为80.00%、94.12%及100%,临床成功率分别为30.00%、82.35%及93.75%;3组间差异均有统计学意义(P均<0.05)。AVF组1、3、6、9及12个月初级通畅率分别为80.00%、30.00%、27.59%、27.59%及24.14%,PTA+AVF组分别为94.12%、82.35%、78.79%、68.75%及62.50%,AVG组分别为100%、93.33%、83.33%、76.67%及66.67%;3组间差异均有统计学意义(P均<0.05)。AVF组1、3、6、9及12个月次级通畅率分别为83.33%、75.00%、75.00%、70.83%及58.33%,PTA+AVF组分别为93.33%、93.33%、83.33%、83.33%及80.00%,AVG组分别为100%、100%、93.33%、90.00%及80.00%;3组间差异亦均有统计学意义(P均<0.05)。结论相比直接及经超声引导下以PTA扩张桡动脉后建立AVF,AVG用于需要接受血液透析而相应血管细小患者效果更佳。Objective To compare the application value of direct arteriovenous fistula(AVF),after ultrasound-guided percutaneous transluminal angioplasty(PTA)dilation of radial artery AVF formation and reverse“J”arteriovenous graft(AVG)in hemodialysis patients with small diameter vessels.Methods Totally 96 end-stage renal disease patients with distal radial artery<1.5 mm and cephalic vein≥2.0 mm who planning to receive hemodialysis were retrospectively enrolled.The patients were divided into AVF group(n=30),PTA+AVF group(n=34)and AVG group(n=32)according to fistulization methods.The technical success rate,clinical success rate,primary patency rate and secondary patency rate were compared among groups.Results The technical success rate of AVF group,PTA+AVF group and AVG group was 80.00%,94.12%and 100%,respectively,and the clinical success rate was 30.00%,82.35%and 93.75%,respectively,with significant differences among 3 groups(both P<0.05).The primary patency rate 1,3,6,9 and 12 months after fistulization in AVF group was 80.00%,30.00%,27.59%,27.59%and 24.14%,respectively,in PTA+AVF group was 94.12%,82.35%,78.79%,68.75%and 62.50%,respectively,while in AVG group was 100%,93.33%,83.33%,76.67%and 66.67%,respectively,all being significant different among 3 groups(all P<0.05).The secondary patency rate 1,3,6,9 and 12 months after fistulization in AVF group was 83.33%,75.00%,75.00%,70.83%and 58.33%,respectively,in PTA+AVF group was 93.33%,93.33%,83.33%,83.33%and 80.00%,respectively,while in AVG group was 100%,100%,93.33%,90.00%and 80.00%,respectively,also being significant different among 3 groups(all P<0.05).Conclusion Compared with direct and after ultrasound-guided PTA dilation of radial artery AVF formation,AVG formation was more valuable for hemodialysis patients with small diameter vessels.

关 键 词：肾透析 动静脉瘘 血管成形术 超声检查 介入性 

分 类 号：R543.5[医药卫生—心血管疾病] R815[医药卫生—内科学]