CAJ | 학술논문

目的：聚四氟乙烯人工血管动静脉内瘘（AVG）是自身血管条件差的尿毒症期患者重要透析备选途径，保持人工血管内瘘的正常功能对这些患者尤为重要。人工血管动静脉内瘘闭塞是临床最常见造成透析通路失功的原因，本文评估 AVG闭塞后不同治疗方法的有效率，总结 AVG闭塞的治疗经验。方法回顾性分析2003年8月至2013年12月在北京大学第一医院血管外科因AVG闭塞就诊86例患者的临床资料。根据闭塞原因、时间及处理方法特点，将AVG闭塞分为急性期、早期、晚期。闭塞24 h以内的为急性期，7 d以内的为早期；7 d以上为晚期。结果急性期28例，行局部溶栓治疗，成功22例，余6例行Fogarty导管取栓。早期26例，行Fogarty导管取栓术，成功21例，余5例行人工血管重建。晚期32例，人工血管重建34例次，包括人工血管静脉端-上臂肱静脉跨越式搭桥8例；人工血管静脉端-上臂贵要静脉跨越式搭桥7例，肱动脉-肱静脉AVG 5例，肱动脉-腋静脉AVG 4例，腋动脉-腋静脉AVG 4例，锁骨下动-静脉AVG 5例，插管透析1例。平均随访时间（29±14）个月（9～108个月）。围手术期死亡率为0。闭塞处理后1年初级通畅率为72.4%，累积次级通畅率为89.6%；2年初级通畅率为58.9%，累积次级通畅率为76.2%。结论 AVG闭塞后针对不同病因治疗可延长人工血管内瘘的使用寿命。急性期和早期AVG闭塞多可通过溶栓、Fogarty导管取栓治愈；晚期AVG闭塞多由于吻合口特别是静脉端内膜增生造成的狭窄、静脉老化等原因，单纯取栓再闭塞率极高，可通过人工血管重建，提高AVG远期通畅率。
목적：취사불을희인공혈관동정맥내루（AVG）시자신혈관조건차적뇨독증기환자중요투석비선도경，보지인공혈관내루적정상공능대저사환자우위중요。인공혈관동정맥내루폐새시림상최상견조성투석통로실공적원인，본문평고 AVG폐새후불동치료방법적유효솔，총결 AVG폐새적치료경험。방법회고성분석2003년8월지2013년12월재북경대학제일의원혈관외과인AVG폐새취진86례환자적림상자료。근거폐새원인、시간급처리방법특점，장AVG폐새분위급성기、조기、만기。폐새24 h이내적위급성기，7 d이내적위조기；7 d이상위만기。결과급성기28례，행국부용전치료，성공22례，여6례행Fogarty도관취전。조기26례，행Fogarty도관취전술，성공21례，여5례행인공혈관중건。만기32례，인공혈관중건34례차，포괄인공혈관정맥단-상비굉정맥과월식탑교8례；인공혈관정맥단-상비귀요정맥과월식탑교7례，굉동맥-굉정맥AVG 5례，굉동맥-액정맥AVG 4례，액동맥-액정맥AVG 4례，쇄골하동-정맥AVG 5례，삽관투석1례。평균수방시간（29±14）개월（9～108개월）。위수술기사망솔위0。폐새처리후1년초급통창솔위72.4%，루적차급통창솔위89.6%；2년초급통창솔위58.9%，루적차급통창솔위76.2%。결론 AVG폐새후침대불동병인치료가연장인공혈관내루적사용수명。급성기화조기AVG폐새다가통과용전、Fogarty도관취전치유；만기AVG폐새다유우문합구특별시정맥단내막증생조성적협착、정맥노화등원인，단순취전재폐새솔겁고，가통과인공혈관중건，제고AVG원기통창솔。
Objective PTFE arteriovenous graft(AVG) is an important backup hemodialysis access in urinemic patients. To maintain the normal function of AVG is particularly important for these patients. AVG occlusion is the most common clinical causes of hemodialysis access disfunctional, this paper evaluated different treatment methods and summarize the treatment experience for AVG occlusion. Methods The clinical data of 86 patients whose AVG for hemodialysis access occluded between August 2003 to December 2013 in Peking University first hospital were analyzed retrospectively. Based on the characteristics, time, and the processing method of occlusion reason, AVG occlusion can be divided into acute, early, late period. Occluded within 24 hours for acute period, within 7 days for early period;More than 7 days for late period. Results 28 cases of acute period were treated by percutaneous thrombolysis, 22 cases succeeded;the other 6 cases were treated by thrombectomy. 26 cases of early period were treated by thrombectomy, 21 cases succeeded, the other 5 cases underwent artificial vascular remodeling. 32 cases were late period, 34 times of artificial vascular remodeling, including AVG venous side-upper arm brachial vein jump graft in 8 cases; AVG venous side-upper arm basilic vein jump graft in 7 cases; Brachial artery-brachial vein AVG in 5 cases;Brachial artery-axillary vein AVG in 4 cases;Axillary artery-axillary vein AVG in 4 cases;Subclavian artery-subclavian vein AVG in 5 cases;Hemodialysis with central venous catheter in 1 case. The mean duration of follow-up were (29±14)months (9-108 months). Perioperative mortality rate was 0. The primary patency rate was 72.4%, 1 year cumulative secondary patency rate was 89.6%;The primary patency rate was 58.9%, 2 years accumulated the secondary patency rate was 76.2%. Conclusion Different etiological treatment for AVG occlusion can prolong the service life of AVG. Acute and early period AVG occlusion can be treated by percutaneous thrombolysis and thrombectomy using Fogarty catheter; Late period AVG occlusion due to intimal hyperplasia anastomotic especially venous anastomosis narrow, is easy to block again. Reconstruction by new artificial vessel can improve long-term patency rate. Proper revision according to different cause of graft occlusions can prolong the service time of the graft.