经皮球囊扩张血管成形术治疗血液透析患者动静脉瘘功能不良

摘要

Objective To investigate the effect of percutaneous transluminal angioplasty (PTA) on autogenous arteriovenous fistula malfunction in hemodialysis patients.Methods A prospective trial was conducted in patients whose arteriovenous fistula (AVF) was salvaged by PTA in our hospital.Results Juxta-anastomosis stenosis was confirmed by fistulogram in 12 AVFs.PTA was performed in 7 AVFs with late malfunction and 5 AVFs with early malfunction.Technical success rate was 91.7％( 1 1/12).In 7 patients with late AVF malfunction, clinical success rate was 85.7％(6/7), and the patients were followed up for 8.6 (3.3～14.8) months.The primary AVF patency rate was 100％.In 5 patients with early AVF malfunction, re-stenosis occurred after 3 months in one patient,and the other 4 AVFs matured eventually.Conclusions PTA successfully improves the fistula patency, and is an effective therapeutic modality for the treatment of AVF malfunction in hemodialysis patients.%目的 观察经皮球囊扩张血管成形术(Percutaneous transluminal angioplasty,PTA)治疗血液透析患者动静脉瘘(arteriovenous fistula,AVF)功能不良的临床疗效.方法 自2010年1月至12月,对在北京大学第一医院肾内科因AVF功能不良行PTA治疗的患者行前瞻性的临床观察.总结患者的临床特点、血管造影结果和PTA治疗的技术指标、临床和技术成功率.术后对患者进行随访,观察AVF通畅率.结果 12例患者AVF狭窄均发生在吻合口附近,行PTA治疗的技术成功率91.7%(11/12).7例晚期功能不良病例临床成功率85.7%(6/7).术后随访8.6(3.3～14.8)个月,AVF1级通畅率为100%.5例AVF早期功能不良患者平均随访8.2(4.1～11.3)个月.1例在PTA术后3个月发生AVF再狭窄,余4例AVF成熟,透析中血流量达200ml/min以上.结论 PTA是治疗血液透析患者AVF功能不良的一个有效手段.