置管溶栓联合经皮穿刺球囊扩张治疗前臂动静脉内瘘急性闭塞的效果

摘要

目的 探讨置管溶栓联合经皮穿刺球囊扩张治疗前臂动静脉内瘘急性闭塞的安全性和有效性.方法 采用经患肢肱动脉远端穿刺行置管溶栓治疗20例前臂动静脉内瘘急性闭塞的患者,对存在血管狭窄并且狭窄程度超过50％的患者行球囊扩张治疗.结果 20例患者经置管溶栓联合经皮穿刺球囊扩张治疗后均成功开通,未发生出血、肺栓塞等严重并发症,术后随访3～6个月,16例动静脉内瘘维持通畅,4例动静脉内瘘再次闭塞,其中2例经再次溶栓及球囊扩张治疗后恢复通畅,2例动静脉内瘘未能开通.结论 置管溶栓联合经皮穿刺球囊扩张是治疗前臂动静脉内瘘急性闭塞的安全、有效的方法.%Objective To assess the safety and efficacy of transcatheter thrombolysis combined with percutaneous puncture balloon dilatation for acute occlusion of forearm arteriovenous fistulas.Methods A total of 20 cases with acute thrombosed arteriovenous fistulas were treated with transcatheter thrombolysis therapy by distal puncture of the brachial artery,and the patients with arteriovenous fistulas stenosis more than 50％ were conducted percutaneous puncture balloon dilatation.Results Acute thrombosed arteriovenous fistulas was dredged in all 20 patients by transcatheter thrombolysis combined with percutaneous puncture balloon dilatation,without serious complications such as hemorrhage,pulmonary embolism and others.After follow-up for 3 to 6 months,16 cases maintained smooth,recurrent thrombosis was founded in 4 cases,among whom 2 were reopened after transcatheter thrombolysis in combination and percutaneous puncture balloon dilatation and 2 failed to dredged.Conclusion Transcatheter thrombolysis in combination with percutaneous puncture balloon dilatation is a safe and effective treatment for patients with acute thrombosed arteriovenous fistulas.