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  • 吕仁华,王涌,陈莉,等.自体动静脉瘘狭窄超声分型对经皮腔内血管成形术短期疗效的预测价值[J].同济大学学报(医学版),2021,42(1):57-61.    [点击复制]
  • L Ren-hua,WANG Yong,CHEN Li,et al.Values of ultrasound typing of autologous arteriovenous fistula stenosis in predicting the short-term efficacy of percutaneous transluminal angioplasty[J].同济大学学报(医学版),2021,42(1):57-61.   [点击复制]
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自体动静脉瘘狭窄超声分型对经皮腔内血管成形术短期疗效的预测价值
吕仁华,王涌,陈莉,何勍,谭晋韵,谢春梅
0
(复旦大学附属华山医院超声医学科,上海200040;复旦大学附属华山医院血管外科,上海200040)
摘要:
目的通过对终末期肾病(end-stage renal disease, ESRD)患者自体动静脉瘘(autogenous arteriovenous fistula, AVF)狭窄进行超声分型,分析经皮腔内血管成形术(percutaneous transluminal angioplasty, PTA)治疗不同类型AVF狭窄的短期疗效。方法对2018年1月1日—2020年5月31日期间在复旦大学附属华山医院血透中心因AVF狭窄入院行超声引导下PTA治疗的47例ESRD患者进行回顾性分析。根据AVF狭窄部位分为动脉型、吻合口型(Ⅰ型)、静脉近吻合口型(Ⅱ型)、静脉型(Ⅲ型),复合型(Ⅳ型)。根据引起AVF狭窄原因分为内膜增生型(A型)、机械缩窄型(B型)、复杂型(C型)和单纯血栓型(D型)。超声引导下PTA治疗后观察不同类型AVF术后狭窄恢复情况、血流动力学变化,比较流量改善情况,以及PTA的技术成功率与短期再狭窄率。结果47例AVF狭窄患者PTA技术成功率91.5%(43/47),其中6例于3个月内再次发生狭窄(6/43,14.0%)。术后肱动脉、输入动脉和引流静脉流量明显高于治疗前(P<0.01)。统计显示47例AVF狭窄中Ⅱ型明显多于Ⅰ、Ⅲ和Ⅳ型(P<0.01),出现内膜增生的A型和C型多于B型和D型(P<0.05)。4例未达到技术成功均为ⅡA型,ⅡA型的短期再狭窄率高于非ⅡA型(P=0.012)。结论超声引导下PTA是治疗AVF狭窄的有效手段,距吻合口5cm内的引流静脉是狭窄好发部位,随访时须重点观察,类型多为A型和C型。其中A型术后流量提高不如B、C型,而ⅡA型采用超声引导下PTA治疗易复发,必要时可考虑开放手术或重新评估后造瘘。
关键词:  超声  自体动静脉瘘  狭窄  经皮腔内血管成形术  终末期肾病
DOI:10.12289/j.issn.1008-0392.20267
投稿时间:2020-06-14
基金项目:
Values of ultrasound typing of autologous arteriovenous fistula stenosis in predicting the short-term efficacy of percutaneous transluminal angioplasty
L Ren-hua,WANG Yong,CHEN Li,HE Qing,TAN Jin-yun,XIE Chun-mei
(Dept. of Ultrasonography, Huashan Hospital, Fudan University, Shanghai 200040, China;Dept. of Vascular Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China)
Abstract:
ObjectiveTo analyze the short-term efficacy of percutaneous transluminal angioplasty (PTA) with ultrasound typing in treatment of different types of autologous arteriovenous fistula(AVF) stenosis in patients with end-stage renal disease (ESRD). MethodsClinical data of 47 ESRD patients admitted to the Hemodialysis Center of Affiliated Huashan Hospital of Fudan University for ultrasound-guided PTA treatment due to AVF stenosis from January 2018 to May 2020 were analyzed retrospectively. According to the location of stenosis, AVF were divided into arterial type, anastomotic type (type Ⅰ), venous proximal anastomosis (type Ⅱ), venous type (type Ⅲ), and complex type (type Ⅳ). According to the causes of stenosis, AVF were divided into intimal hyperplasia type (type A), mechanical constriction type (type B), complex type (type C) and simple thrombus type (type D). The postoperative stenosis recovery, hemodynamic changes, flow improvement, PTA technical success rate and short-term restenosis rate of different types AVF after treatment were observed. ResultsThe success rate of PTA technique in 47 patients with AVF stenosis was 91.5%(43/47), and the AVF stenosis occurred again in 6 cases within 3 months (6/43,14.0%). After operation, the flow of brachial artery, input artery and drainage vein was significantly higher than that before treatment (P<0.01), which of type Ⅱ was more markedly than that of type Ⅰ, Ⅲ and Ⅳ in 47 cases, (P<0.01), and which of types A and C with intimal hyperplasia were more markedly than that of types B and D (P<0.05). Four cases without technical success were type ⅡA, and the short-term restenosis rate of type ⅡA was higher than that of non-type ⅡA (P=0.012). ConclusionUltrasound-guided PTA is an effective method for the treatment of AVF stenosis. The drainage vein within 5 cm from the anastomosis is the site of stenosis. The postoperative flow rate of type A is not as high as that of type B and type C, while the treatment of type ⅡA with ultrasound guidance is easy to relapse, and open surgery or re-evaluation of post-fistula may be considered if necessary.
Key words:  ultrasound  autogenous arteriovenous fistula  stenosis  percutaneous transluminal angioplasty  end-stage renal disease

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