多普勒回声引导血管成形术治疗血液透析动静脉瘘狭窄

E. M. Torres, M. M. Joan, Laura Calsina Juscafresa, Carlos Ruiz Carmona, A. C. Velasco
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摘要

导读:血液透析中动静脉瘘(AVF)路径狭窄是一个非常普遍的问题,经皮血管成形术(PTA)治疗有很长的经验。然而,这些手术涉及不可忽视的设备要求,暴露于辐射和静脉造影剂,这些对患者不利,使其表现更加复杂。本研究回顾了我们在多普勒超声引导下血管成形术的初步经验。方法:前瞻性队列研究采用多普勒超声引导PTA治疗明显静脉狭窄导致的先天性AVF功能障碍患者。超声引导下进行AVF穿刺、病变置管、球囊定位充气及结果验证。在扩张前和扩张后分别进行一次瘘管造影。作为对照,在同一时期通过常规血管造影方法进行的病例也被收集。结果:2015年2月至2018年9月,对先天性AVF进行了51例pta,其中27例有回声(平均年龄65.3岁;63%的男性)。技术成功率为96%。在26%的病例中,由于血管造影后残留狭窄而重复PTA。围手术期并发症7.3%。92%的avf在24小时内被刺破。1个月、6个月和1年初通畅率分别为100%、64.8%和43.6%,辅助通畅率分别为100%、87.2%和74.8%。血管造影引导下AVF血管成形术的即时或后期结果无显著差异。结论:在多普勒超声引导下,AVF-PTA可以安全有效地进行,简化了其操作所需的后勤保障,但我们仍需提高该成像技术对结果的早期验证能力。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Doppler-echo guided angioplasty in the treatment of arterio-venous fistula stenosis for hemodialysis
Introduction: Stenoses in the path of arteriovenous fistulas (AVF) for hemodialysis are a very prevalent problem and there is long experience in their treatment by percutaneous angioplasty (PTA). These procedures, however, involve non-negligible equipment requirements, exposure to radiation and intravenous contrast that are not beneficial for the patient and make their performance more complex. This study reviews our initial experience with Doppler ultrasound-guided angioplasty. Methods: Prospective cohort of patients with native AVF dysfunction due to significant venous stenosis treated by Doppler echo-guided PTA. AVF puncture, lesion catheterization, balloon localization and inflation, and outcome verification were performed under ultrasound guidance. Only one fistulography was performed before and another one after dilatation. As a control, the cases performed during the same period by the usual angiographic method were also collected. Results: Between February 2015 and September 2018, 51 PTAs were performed on native AVF, of which 27 were echogenic (mean age, 65.3 years; 63% male). The technical success rate was 96%. In 26% of cases, PTA was repeated due to residual stenosis after angiographic imaging. There were 7.3% periprocedural complications. 92% of the AVFs were punctured at 24 hours. Primary patency at 1 month, 6 months and 1 year was 100%, 64.8% and 43.6%, and assisted patency was 100%, 87.2% and 74.8%. There were no significant differences in immediate or late results with respect to angiographically guided AVF angioplasty. Conclusions: AVF-PTA can be performed safely and effectively guided by Doppler ultrasound, which simplifies the logistics required for its performance, although we still need to improve the capacity for early verification of the result with this imaging technique.
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