中国血液净化

›› 2003, Vol. 2 ›› Issue (2): 62-63.

• 论著 •    下一篇

经皮血管成形术治疗内瘘管狭窄

李保春 张必嘏 郭志勇 许 静 翟振燕 袁伟杰

  

  1. 200433 上海， 第二军医大学第一附属医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2003-02-19 发布日期:2003-02-19

  • Received:1900-01-01 Revised:1900-01-01 Online:2003-02-19 Published:2003-02-19

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摘要： 【摘要】目的 应用经皮血管成形术（PTA）治疗动静脉内瘘管狭窄，探讨治疗内瘘管狭窄的新途径。方法 血液透析患者两例，均出现血液透析时内瘘管血流量不足。选择患者肘动脉为穿刺点，18G针头为穿刺针，0.09cm导丝，7F鞘管，优微显为造影剂。造影确定狭窄部位后，选择与紧邻狭窄区上游或下游的正常血管直径相近的扩张气囊，将扩张气囊在荧屏监视下置于狭窄区，用充满50%稀释的造影剂的压力计进行充气，压力缓慢增加致狭窄在气囊作用下消失，其边缘与未狭窄部位完全平行。扩张持续时间为 15秒 ,压力为15个大气压。结果 经皮腔内血管成形术后，即感血管震颤较扩张前明显增强，第二天透析时血流量明显增加，可完全满足透析需要。瘘管使用半年余，血流量持续维持在200 ml/min，未发生扩张部位再狭窄。结论 PTA是治疗动静脉内瘘狭窄的有效方法之一，操作简单，创伤小，可选择适宜患者采用。

关键词: 动静脉内瘘管, 狭窄, 经皮血管成形术

Abstract:

【Abstract】Objective Using the percutaneous transluminal angioplasty (PTA) to treat the stenosis of arteriovenous access and founding the new way to deal with the stenosis of arteriovenous access.Methods Two cases were chosen with insufficient inflow of native fistula in hemodialysis patients. Elbow artery was chosen as puncture point. 18G needles, 0.09cm guidewire, 7F introducer-sheath and ultravist were provided to the operation. After diagnostic angiography to define the stenosis, dilation balloon which diameter equal the diameter of the immediately upstream or downstream normal vessel was placed through the stenosis under fluoroscopic guidance. It was inflated with a manometer filled with contrast medium dilute to 50%. Pressure was slowly increased to abolish the waist of stenosis on the balloon, the edges of which must be completely parallel, the dilation time was 15 second, the pressure was 15 atm. Results The thrill of arteriovenous access became strong immediately after the PTA and the blood flow rate increased significantly during the next day hemodilysi with sufficient inflow. The blood flow rate maintained 200ml/min for more than half year and there was no restenosis of arteriovenous access. Conclusion PTA is a effective method to treat the stenosis of arteriovenous access with easy operation, minimal trauma and can be performed for certain patients.

Key words: Stenosis, Percutaneous transluminal angioplasty (PTA)