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中华介入放射学电子杂志 ›› 2020, Vol. 08 ›› Issue (04) : 309 -314. doi: 10.3877/cma.j.issn.2095-5782.2020.04.004

所属专题: 总编推荐 文献

血管介入

经不同动脉入路治疗完全闭塞型自体动静脉内瘘的疗效及安全性观察
张慧涛1, 汪娟2, 王大帅1, 郭辉1, 胡晓俊1, 赵逆1, 黄伟乐1, 庞鹏飞1,()   
  1. 1. 519000 广东珠海,中山大学附属第五医院介入医学中心介入血管外科
    2. 519000 广东珠海,中山大学附属第五医院健康管理中心
  • 收稿日期:2020-10-05 出版日期:2020-11-25
  • 通信作者: 庞鹏飞
  • 基金资助:
    珠海市科技计划项目(2015A0006)

Observation on the efficacy and safety of different arterial approaches in the treatment of completely occlusive autologous arteriovenous fistula

Huitao Zhang1, Juan Wang2, Dashuai Wang1, Hui Guo1, Xiaojun Hu1, Ni Zhao1, Weile Huang1, Pengfei Pang1,()   

  1. 1. Department of Interventional Vascular Surgery, Interventional Medical Centre, Guangdong Zhuhai 519000, China
    2. Department of Health Management Center, the Fifth Affiliated Hospital of Sun Yat-sen University, Guangdong Zhuhai 519000, China
  • Received:2020-10-05 Published:2020-11-25
  • Corresponding author: Pengfei Pang
  • About author:
    Corresponding author: Pang Pengfei, Email:
引用本文:

张慧涛, 汪娟, 王大帅, 郭辉, 胡晓俊, 赵逆, 黄伟乐, 庞鹏飞. 经不同动脉入路治疗完全闭塞型自体动静脉内瘘的疗效及安全性观察[J/OL]. 中华介入放射学电子杂志, 2020, 08(04): 309-314.

Huitao Zhang, Juan Wang, Dashuai Wang, Hui Guo, Xiaojun Hu, Ni Zhao, Weile Huang, Pengfei Pang. Observation on the efficacy and safety of different arterial approaches in the treatment of completely occlusive autologous arteriovenous fistula[J/OL]. Chinese Journal of Interventional Radiology(Electronic Edition), 2020, 08(04): 309-314.

目的

探讨经股动脉及肱动脉入路腔内血管成形术(percutaneous trans1uminal angioplasty,PTA)联合置管溶栓治疗完全闭塞型自体动静脉内瘘(arteriovenous fistula,AVF)的疗效、安全性及AVF远期通畅状况。

方法

回顾性分析我院2016年3月至2018年6月期间收治的53例AVF闭塞且经动脉入路行PTA联合置管溶栓治疗的病例。分析患者基线资料、手术结局、并发症、射线暴露时间及剂量,随访观察患者AVF的通畅时间及通畅率。

结果

经过治疗的53例AVF闭塞的患者中,成功48例,失败5例,总体技术成功率为90.6%;肱动脉入路组成功率优于股动脉入路组,两组之间差异有统计学意义(其中P<0.05);两组之间并发症差异(P=0.234)及初级通畅率差异(P=0.278)无统计学意义;在统计手术射线暴露时间时发现,股动脉入路组射线暴露时间为(2 601.5±1 803.9)s,远长于肱动脉入路的(1 191.8±844.5)s,差异有统计学意义(P<0.05);肱动脉入路组射线的暴露剂量为(25.15±26.06)mGy,明显小于股动脉入路组的剂量(97.58±69.85)mGy,差异有统计学意义(P<0.05)。

结论

经股动脉及肱动脉入路PTA联合置管溶栓可以有效治疗完全闭塞型AVF,且术后的AVF在持续随访中有较好的远期通畅性;但在手术时射线暴露时间及剂量方面,肱动脉入路组明显优于股动脉入路组。

Objective

To investigate the efficacy, safety and long-term patency of transfemoral and brachial artery percutaneous transluminal angioplasty (PTA) combined with thrombolysis in the treatment of completely occlusive autologous arteriovenous fistula (AVF).

Methods

From March 2016 to June 2018, 53 patients with AVF occlusion who underwent PTA combined with thrombolysis via arterial approach were analyzed retrospectively. The baseline data, surgical outcome, complications, radiation dose and fluoroscopy time were analyzed, and the patency time and patency rate of AVF were observed.

Results

Among the53 patients with AVF occlusion, 48 cases were successful and 5 failed, with an overall technical success rate of 90.6%. The power of brachial artery approach was better than that of femoral artery approach with significant difference (P<0.05), but there were no significant differences in complications and primary patency rate between the two groups. The fluoroscopy time in the femoral artery approach group was (2 601.5 ±1 803.9) s, which was much longer than that in the brachial artery approach group [(1 191.8±844.5) s] with significant difference (P<0.05), and the radiation dose in the brachial artery approach group [(25.15 ±26.06) s] was significantly lower than that in the femoral artery approach group [(97.58 ±69.85) s](P< 0.05).

Conclusions

PTA combined with thrombolysis via femoral artery and brachial artery approach can effectively treat completely occlusive AVF, and postoperative AVF has good long-term patency during continuous follow-up. The brachial artery approach group is significantly better than the femoral artery approach group in terms of radiation dose and fluoroscopy time during operation.

表1 两组之间一般资料比较[n=53,例(%)]
表2 两组之间手术成功率比较[例(%)]
表3 两组之间并发症发生率比较[例(%)]
表4 随访至2019年12月两组之间初级通畅率的比较[例( %)]
表5 两组之间手术时射线暴露时间比较(n=53)
表6 两组之间手术时射线暴露剂量(CAK)比较(n=53)
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