明志兵MING Zhibing

丁文彬1DING Wenbin

袁瑞凡1YUAN Ruifan

李文东2LI Wendong

李晓强2LI Xiaoqiang

冠状动脉球囊开通失功能动静脉瘘管的应用

明志兵1MING Zhibing

丁文彬1DING Wenbin

袁瑞凡1YUAN Ruifan

李文东2LI Wendong

李晓强2LI Xiaoqiang

作者单位
1. 南通大学第二附属医院介入科 江苏南通226001
2. 苏州大学附属第二医院血管外科 江苏苏州 215004

Department of Interventional Radiology，the Second Affiliated Hospital of Nantong University， Nantong 226001， China

Address Correspondence to： MING Zhibing

E-mail： mzbdoctor@163.com

2016-01-06

中国医学影像学杂志

2016年 第24卷 第7期：515-518，523

Chinese Journal of Medical Imaging

2016 Volume 24 （7）： 515-518， 523

目的 应用冠状动脉球囊对失功能动静脉瘘管（AVF）行经皮腔内血管成形术（PTA），评估其可行性及临床价值。资料与方法 回顾性研究103例AVF失功能患者行PTA后的临床资料及影像学表现，分为冠状动脉球囊组53例和普通球囊组50例。经肱动脉顺行穿刺，对狭窄或闭塞瘘管行PTA，比较冠状动脉球囊组与普通球囊组治疗后的开通成功率、1年通畅率及血管痉挛、血肿、假性动脉瘤形成情况。结果 瘘管平均长度（2.1±1.3）cm，冠状动脉球囊组技术成功率为86.8%，临床成功率为92.5%，1年通畅率为84.9%；2例（3.8%）患者发生I～II度瘘管痉挛，血肿发生率为5.7%，假性动脉瘤发生率为3.8%。普通球囊组技术成功率为88.0%，临床成功率为92.0%。1年通畅率为68.0%，4例（8.0%）发生I～II度瘘管痉挛，11例（22.0%）发生Ⅲ～Ⅳ度瘘管痉挛；血肿发生率为6.0%，假性动脉瘤发生率为4.0%。冠状动脉球囊组与普通球囊组技术成功率及临床成功率差异无统计学意义（χ2=0.034、0.007，P＞0.05），1年通畅率及痉挛发生率差异有统计学意义（χ2=4.114、12.841，P＜0.05）；血肿及假性动脉瘤发生率差异无统计学意义（χ2=0.005、0.004，P＞0.05）。结论 冠状动脉球囊开通AVF失功能后通畅率高、副作用更少，具有临床推广价值。

肾透析；动静脉瘘；血管成形术，气囊

【Abstract】Purpose To assess the clinical significance of the coronary artery balloon via percutaneous transluminal angioplasty （PTA） in treatment of ateriovenous fistula （AVF）. Materials and Methods A total of 103 patients with AVF dysfunction were recruited. The clinical data and imaging data of all patients were collected and analyzed. PTA was performed with coronary artery balloon in 53 patients and with regular balloon in 50 patients. The success rate of vessel patency， 1 year vessel patency， vasospasm， hematoma，and pseudoaneurysm were compared between the two groups.Results The mean length of fistula was （2.1±1.3） cm. For coronary artery balloon treated cases， the technical and clinical success rate of vessel patency and 1 year vessel patency were 86.8%， 92.5% and 84.9%， respectively. The frequencies of class I-II vasospasm， hematoma， and pseudoaneurysm were 3.8%， 5.7% and 3.8%， respectively. For regular balloon treated cases， the technical and clinical success rate of vessel patency and 1 year vessel patency was 88.0%， 92.0% and 68.0%， respectively. The frequencies of I-II vasospasm， class III-IV vasospasm， hematoma， and pseudoaneurysm were 8.0%， 22.0%， 6.0% and 4.0%，respectively. The difference of technical and clinical success rate between the two groups were not statistic （χ2=0.034 and 0.007， P＞0.05）. There was significant difference in the presence of 1 year patency and vasospasm （χ2=4.114 and 12.841， P＜0.05） between the two groups， but not in hematoma and pseudoaneurysm （χ2=0.005 and 0.004， P＞0.05）. Conclusion PTA with coronary artery balloon has advantages in treating patients with AVF dysfunction， which include high success rate， high patency， and fewer adverse event. It might be further applied in the clinical practice.

【Key words】Renal dialysis； Arteriovenous fistula； Angioplasty， balloon

肾功能不全晚期可引起尿毒症，必须顺行维持性血液透析，通畅的血液透析通路是保证患者生存率及生活质量的重要因素。……