本文選題：血液透析 + 自體動靜脈內瘺　； 參考：《介入放射學雜志》2017年08期

【摘要】：目的探討經皮血管支架植入術(PTS)治療自體動靜脈內瘺(AVF)透析患者中心靜脈阻塞(CVO)可行性及臨床應用價值。方法回顧性分析10例AVF伴CVO患者,臨床均表現(xiàn)為手腫脹綜合征。術前或術中均接受DSA檢查明確阻塞部位,根據(jù)不同病情采用合適手術入路,伴有血栓形成患者先行導管接觸溶栓(CDT),嚴重狹窄或閉塞患者先以小直徑球囊預擴張遂行PTS,其余患者直接行PTS。結果 DSA顯示5例有頸內靜脈置管史患者為頭臂靜脈閉塞或/和鎖骨下靜脈、頸內靜脈、上腔靜脈閉塞或狹窄,5例無頸內靜脈置管史患者均表現(xiàn)為內瘺側鎖骨下靜脈內側段局限性嚴重狹窄。10例PTS技術成功率為100%,植入支架19枚,1例(鎖骨下靜脈狹窄)術后7個月支架內再狹窄再行PTS術。一期通暢率在術后6個月為8/8,術后1年為3/4。結論 AVF透析患者CVO多為閉塞性或嚴重狹窄病變,PTS治療成功率高、近中期效果滿意、并發(fā)癥輕微,安全有效、可行,可作為首選治療方法。
[Abstract]:Objective to investigate the feasibility and clinical value of percutaneous transluminal stent implantation (PTSs) in the treatment of central vein occlusion (CVOO) in patients with AVF. Methods Ten cases of AVF with CVO were retrospectively analyzed. Preoperative or intraoperative DSA examination was performed to determine the location of obstruction, and appropriate operative approaches were adopted according to different conditions. Patients with thrombus were treated with catheter contact thrombolytic thrombolytic thrombolysis (CDT). The patients with severe stenosis or occlusion were performed PTSs with small diameter balloon dilatation first, and the others with PTSs directly. Results DSA showed that 5 patients with history of internal jugular vein catheterization were occluded or / or subclavian vein and internal jugular vein. 5 cases of superior vena cava occlusion or stenosis without history of internal jugular vein indwelling showed severe local stenosis of medial segment of subclavian vein of internal fistula. Success rate of PTS technique was 100%, and 19 stents were implanted in 1 case (subclavian vein stenosis). PTS was performed 7 months after stent restenosis. The primary patency rate was 8 / 8 at 6 months and 3 / 4 at 1 year. Conclusion CVO in AVF dialysis patients with occlusive or severe stenosis has a high success rate, satisfactory results in the near and middle stage, mild complications, safety and effectiveness, and can be used as the first choice for the treatment.
【作者單位】： 上海交通大學醫(yī)學院附屬蘇州九龍醫(yī)院介入血管外科;
【分類號】：R692.5

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