CAJ | 학술논문

目的探讨常规球囊扩张失败的动静脉内瘘狭窄应用切割球囊治疗的临床疗效及安全性. 方法前瞻性选取2011年12月至2015年2月常规球囊行经皮腔内血管成型术(percutaneous transluminal angioplasty, PTA)后残余狭窄>30%的患者,切割球囊PTA后每3个月复查. 结果共25例患者,年龄(60.7±12.9)岁,其中自体动静脉内瘘(autogenous arterio?venous fistulas ,AVF)11例,移植物内瘘(arterio?venous graft, AVG)14例.切割球囊PTA共30例次,技术成功率86.7%,临床成功率100%.治疗前后血管内径分别为(1.7±0.6)mm和(4.5± 0.8)mm(P<0.05).6例患者存在多处狭窄.静脉流出道狭窄21例;静脉吻合口狭窄6例;头静脉弓狭窄6例;动脉狭窄2例;人造血管穿刺点狭窄1例.AVF组首次开通率为3个月70.0%,6个月10.0%;AVG组首次开通率为3个月64.3%,6个月7.1%(P>0.05). AVF组再次开通率为3个月70.0%,6个月30.0%;AVG组再次开通率3个月85.7%,6个月64.3%(P>0.05).术后随访时间(8.1±7.3)个月,再狭窄率为64.0%.4例次切割球囊PTA后残余狭窄>30%, 2例植入覆膜支架,2例应用超高压球囊PTA均达到技术成功.内瘘中位生存时间为173 d.结论常规球囊扩张失败的严重钙化病变及"球囊腰"病变,切割球囊治疗的近期疗效及安全性值得肯定,经过反复的PTA可维持内瘘远期通畅,但不推荐替代常规球囊而作为一线治疗.切割球囊在AVF和AVG狭窄中的疗效优劣,以及其与高压球囊在效价方面的比较有待大样本、前瞻性、对照研究的结果.
목적 탐토상규구낭확장실패적동정맥내루협착응용절할구낭치료적림상료효급안전성. 방법 전첨성선취2011년12월지2015년2월상규구낭행경피강내혈관성형술(percutaneous transluminal angioplasty, PTA)후잔여협착>30%적환자,절할구낭PTA후매3개월복사. 결과 공25례환자,년령(60.7±12.9)세,기중자체동정맥내루(autogenous arterio?venous fistulas ,AVF)11례,이식물내루(arterio?venous graft, AVG)14례.절할구낭PTA공30례차,기술성공솔86.7%,림상성공솔100%.치료전후혈관내경분별위(1.7±0.6)mm화(4.5± 0.8)mm(P<0.05).6례환자존재다처협착.정맥류출도협착21례;정맥문합구협착6례;두정맥궁협착6례;동맥협착2례;인조혈관천자점협착1례.AVF조수차개통솔위3개월70.0%,6개월10.0%;AVG조수차개통솔위3개월64.3%,6개월7.1%(P>0.05). AVF조재차개통솔위3개월70.0%,6개월30.0%;AVG조재차개통솔3개월85.7%,6개월64.3%(P>0.05).술후수방시간(8.1±7.3)개월,재협착솔위64.0%.4례차절할구낭PTA후잔여협착>30%, 2례식입복막지가,2례응용초고압구낭PTA균체도기술성공.내루중위생존시간위173 d.결론 상규구낭확장실패적엄중개화병변급"구낭요"병변,절할구낭치료적근기료효급안전성치득긍정,경과반복적PTA가유지내루원기통창,단불추천체대상규구낭이작위일선치료.절할구낭재AVF화AVG협착중적료효우렬,이급기여고압구낭재효개방면적비교유대대양본、전첨성、대조연구적결과.
Objective To investigate the efficacy and safety of cutting balloon angioplasty for the treatment of hemodialysis arteriovenous fistula stenosis resistant to conventional percutaneous transluminal angioplasty (PTA). Methods The patients with arteriovenous fistula stenosis who had suboptimal results (residual stenosis >30%) by conventional PTA from December 2011 to February 2015 were enrolled. All the patients received cutting balloon angioplasty were rechecked every three months. Results A total of 25 patients with age of (60.7 ± 12.9) years had suboptimal PTA results. Eleven patients with native arteriovenous fistula (AVF) and 14 patients with graft fistula (AVG) underwent cutting PTA for 30 times. The technical success rate was 86.7% and clinical success rate was 100%. The diameter stenosis pre-procedural and post-procedural of cutting PTA was (1.7±0.6) mm and (4.5 ± 0.8) mm respectively (P<0.05). Six patients had multiple lesions and the stenosis consisted of 21 outflow venous, 6 graft-to-vein anastomosis, 6 cephalic arch, 2 artery and 1 puncture hole stenosis. The primary access patency at 3 and 6 months for AVF group were 70.0% and 10.0%, while for AVG group the figures were 64.3% and 7.1% (P>0.05). The secondary access patency at 3 and 6 months for AVF group were 70.0% and 30.0%, while for AVG group the figures were 85.7% and 64.3% (P>0.05). The follow-up time was (8.1 ± 7.3) months. The restenosis rate was 64.0%. Cutting PTA failed to achieve technical success for four times, of whom 2 patients required graft stent implantation and 2 patients required ultra-high-pressure balloons angioplasty to finally achieve technical success. The median survival time of fistula was 173 days. Conclusions Cutting balloon angioplasty have well short-term patency and safety in arteriovenous fistula stenosis resistant to conventional PTA, especially for calcified lesion or "balloon waist". Although it could provide a satisfied long patency by recurrent PTA, the use of cutting balloon would be not advocated as the first-line treatment for fistula stenosis. The efficacy superiority of cutting balloon between AVF and AVG, as well as the cost-effect comparison between cutting balloon and high-pressure balloon, remains unclear, the verification of which requires large-sampled, prospective and randomized studies.