关键词: 血液透析, 上腔静脉闭塞, 腔内治疗, 血管成形术

Abstract: 【Abstract】Objective To investigate the safety and clinical efficacy of guidewire hard tip puncture technique in the treatment of hemodialysis related superior vena cava occlusion. Methods Clinical data of the 37 patients with hemodialysis-related superior vena cava occlusion and treated with guidewire hard tip puncture for recanalization were retrospectively analyzed. These patients underwent the operation of superior vena cava recanalization and tried to place tunnel-cuffed catheters (TCC). Preoperative and postoperative blood flow in TCC catheter, urea clearance (Kt/V) and urea reduction ratio (URR) were compared. Success rate of the surgical technique, perioperative severe complications and incidence of TCC-related complications were calculated after the operation for 3 months. Results The technical success rate of the surgical treatment was 91.9% (34/37). The rate of severe perioperative complications was 2.7% (1/37). Three patients failed to open the superior vena cava; two patients developed a small mediastinal hematoma and improved after conservative treatment; one patient experienced pericardial tamponade during endovascular manipulation and recovered after draining by pericardiocentesis. Postoperative blood flow in TCC, Kt/V value and urea reduction rate (URR) improved significantly as compared with those before operation. There were no TCC- related complications in the 3 months of follow-up period. Conclusions The guidewire hard tip puncture technology for recanalization of
the superior vena cava occlusion was safe and effective. Skilled and cautious surgical operation is the key to successfully rEopen the occlusion.

Key words: Superior vena cava, Renal dialysis, Angioplasty