CAJ | 학술논문

目的评估3种不同的经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)治疗自体动静脉内瘘(arteriovenous fistula,AVF)失功能的可行性及临床价值,并分析PTA引起瘘管痉挛情况.方法回顾性分析88例AVF失功能患者112次腔内手术的临床资料及影像数据.临床结果包括:临床成功率、技术成功率及瘘管痉挛情况,患者变量包括:年龄、性别、原发病、瘘管种类、使用时间、瘘管狭窄长度、PTA后残余狭窄率.结果瘘管平均长度(2.0±1.4) cm,单纯经肱动脉途径技术成功率80.4％,临床成功率92.8％,2.1％发生瘘管Ⅰ～Ⅱ度痉挛;顺瘘管静脉途径技术成功率85.7％,临床成功率100％,28.6％发生瘘管Ⅱ度痉挛;经肱动脉途径及逆瘘管静脉途径吻合口开通技术成功率25％,临床成功率50％,37.5％发生瘘管Ⅲ～Ⅳ度痉挛.两种途径比较,技术、临床成功率差异有统计学意义(P =0.000、0.019;P=0.000、0.029),痉挛率差异有统计学意义(P=0.000).结论腔内治疗在开通AVF失功能方面疗效肯定,尤其选用冠状动脉球囊治疗不伴明显迂曲及静脉瘤的AVF,疗效及安全性更好,不良反应更少.
목적 평고3충불동적경피강내혈관성형술(percutaneous transluminal angioplasty,PTA)치료자체동정맥내루(arteriovenous fistula,AVF)실공능적가행성급림상개치,병분석PTA인기루관경련정황.방법 회고성분석88례AVF실공능환자112차강내수술적림상자료급영상수거.림상결과포괄:림상성공솔、기술성공솔급루관경련정황,환자변량포괄:년령、성별、원발병、루관충류、사용시간、루관협착장도、PTA후잔여협착솔.결과 루관평균장도(2.0±1.4) cm,단순경굉동맥도경기술성공솔80.4％,림상성공솔92.8％,2.1％발생루관Ⅰ～Ⅱ도경련;순루관정맥도경기술성공솔85.7％,림상성공솔100％,28.6％발생루관Ⅱ도경련;경굉동맥도경급역루관정맥도경문합구개통기술성공솔25％,림상성공솔50％,37.5％발생루관Ⅲ～Ⅳ도경련.량충도경비교,기술、림상성공솔차이유통계학의의(P =0.000、0.019;P=0.000、0.029),경련솔차이유통계학의의(P=0.000).결론 강내치료재개통AVF실공능방면료효긍정,우기선용관상동맥구낭치료불반명현우곡급정맥류적AVF,료효급안전성경호,불량반응경소.
Objective To assess the feasibility and effectiveness of percutaneous transluminal angioplasty (PTA)for the salvage of immature arteriovenous fistula (AVF) and to identify the incidence of arterial and venous puncture site spasm.Methods The medical records and radiological data of 88 patients with 112 interventional procedures for immature AVFs were retrospectively reviewed.Results The stenosis lesions were (2.0 ± 1.4) cm long.Technical success rate and clinical success rate were 80.4％ (78/97) and 92.8％ (90/97) for PTA via brachial artery,85.7％ (6/7) and 100％ (7/7) for PTA via vein,25％ (2/8) and 50％ (4/8) for PTA via both brachial artery and vein,respectively.Spasm of pure arterial PTA occurred in 2 patients (2.1％) and was mild and moderate.Spasm of pure venous PTA occurred in 2 patients (28.6％) and was both moderate.Spasm of combined arterial and venous PTA occurred in 3 patients (37.5％) and from being severe to completely occluded.By comparison,there were statistical differences of technical and clinical success rate (P =0.000,0.019 ; P =0.000,0.029),fistulas spasm rate was statistically significant different (P =0.000).Conclusions Endovascular therapy was effective in restoring the dysfunctional native AVFs,it was safer and more effective and with less sideeffects especially in selecting coronary balloon to treat patients without large phlebangioma and round fistulas.