血液透析患者上肢动静脉内瘘狭窄或闭塞的介入治疗

目的探讨经皮球囊导管血管成形术治疗上肢动静脉内瘘狭窄和闭塞的疗效。方法14例上肢动静脉内瘘狭窄和闭塞的患者,对比术前和术后的临床表现、彩色多普勒超声、血透时血流量的改变及血管造影改变。结果所有病例经球囊扩张后,狭窄段明显扩张,闭塞处再通,经造影证实狭窄小于30%。结论球囊成形术是治疗动静脉内瘘狭窄和闭塞的有效方法,其操作简单、创伤小、安全、近期效果明显。     

血液透析动静脉内瘘狭窄及血栓形成原因分析与护理对策

动静脉内瘘是慢性肾衰竭透析患者赖以生存的血管通路，而血管狭窄及血栓形成是血液透析患者通路最常见的并发症。我们对我院11例反复发生血管狭窄及血栓形成的血液透析患者的临床资料进行回顾性分析，现将血液透析患者动静脉内瘘狭窄及血栓形成的原因及其护理对策探讨如下。     

血液透析动静脉内瘘狭窄和闭塞的造影及介入治疗

目的 探讨血液透析患者动静脉内瘘狭窄和闭塞的血管造影诊断及介入治疗的可行性.方法 对24例慢性肾功不全尿毒症期行血液透析合并动静脉内瘘狭窄和闭塞患者,直接穿刺肱动脉或桡动脉并经穿刺针外鞘行血管造影,确定病变部位后经导管导丝行机械捣栓、注射溶栓药物或行血管成形治疗.结果 12例血栓形成闭塞者行导管导丝机械捣栓及注射溶栓药物治疗;6例血管狭窄者经静脉流出道穿刺插管行药物溶栓及血管成形术,其中1例加行流出道分支静脉栓塞术;6例行外科手术治疗.术后狭窄段通畅,即时开通率达100%.随访10～24个月,未见复发.结论 直接穿刺肱动脉或桡动脉并行血管造影及血管成形术有助于血液透析动静脉内瘘机能不全和闭塞的诊断,是一种安全、简单、有效的介入治疗方法.     

血液透析动静脉内瘘急性血栓形成的溶栓治疗

目的　探讨经导管溶栓治疗血液透析动静脉内瘘急性血栓形成的价值。方法　对 32例慢性肾功能不全尿毒症期行血液透析患者的动静脉内瘘急性血栓形成进行经导管脉冲喷射药物机械溶栓法治疗。结果　经造影证实为急性血栓形成的 32例患者 ,治疗后即时开通率为 97% (31/ 32 ) :1例技术失败。溶栓治疗后造影 ,闭塞段均重新开放。术后随访发现 4例发生再次闭塞 ,其中 2例经再次同法治疗后恢复通畅 ,另 2例患者因发现有局限性血管狭窄而行经皮腔内血管成形术而恢复通畅。术后所有患者未出现肺栓塞及出血等并发症。结论　经导管脉冲喷射药物机械溶栓法是治疗动静脉内瘘急性血栓形成的安全、有效、微创的方法 ,具有较高的即时开通率。对伴有血管狭窄的患者 ,在经导管脉冲喷射药物机械溶栓法治疗的基础上 ,综合经皮血管成形及支架植入术可以提高远期开通率     

前臂动静脉内瘘术狭窄血管内介入治疗的临床意义

目的探讨糖尿病血液透析患者前臂动静脉内瘘术狭窄的血管内介入治疗的疗效及方法。方法 5例患者中4例经患侧肱动脉穿刺、1例经右侧股动脉穿刺,行前臂动脉DSA检查及动静脉内瘘术狭窄血管内球囊成形术（PTA）。结果 5例狭窄程度达到90%～98%,范围4～9cm,血管内球囊成形术后狭窄程度改善到10%以下,技术成功率达100%,无严重并发症发生。结论前臂动静脉内瘘术狭窄血管内球囊成形术是安全有效的治疗方法。     

血液透析动静脉内瘘血管狭窄和闭塞的介入治疗

目的探讨经导管溶栓、经皮血管成形术(PTA)治疗血液透析动静脉内瘘狭窄和闭塞的可行性和有效性。方法对25例自体血管血液透析动静脉瘘道狭窄和闭塞患者行血管造影,18例血栓形成闭塞患者经导管尿激酶溶栓治疗,16例血管狭窄行PTA。结果 25例造影显示血栓闭塞18例,单纯性狭窄7例;经溶栓治疗开通16例,即时开通率88.9%(16/18)。溶栓开通16例中9例显示血管狭窄,该9例与单纯性狭窄7例共16例进行了PTA治疗,成功14例,失败2例,术后所有病例未发生肺梗塞、出血等并发症。溶栓完全开通或PTA成功后,即感血管震颤较前明显增强,次日透析时血流量达到250mL/min,可完全满足透析需要。结论经导管溶栓和PTA是治疗动静脉内瘘血栓形成和血管狭窄的安全、有效和微创的方法,经导管溶栓具有较高的开通率;对栓塞伴有血管狭窄的患者,在溶栓的基础上,结合PTA可提高远期开通率。     

自体动静脉内瘘功能不良的治疗现状及进展

自体动静脉内瘘是慢性肾功能衰竭长期透析患者的生命线，随着时间延长，可出现内瘘血管狭窄、闭塞、血栓形成等并发症，导致内瘘功能不良，影响透析患者的生活质量，主要治疗方法有经皮球囊扩张成形术、支架置入术、尿激酶局部溶栓和外科手术等，该文就自体动静脉内瘘功能不良的治疗现状及进展做一综述。     

透析通路再狭窄不同手术处理

目的 总结评价开放手术、腔内介入术和复合手术治疗血液透析通路动静脉内瘘再狭窄或闭塞的可行性和安全性.方法 回顾性分析2012年1月至2013年12月接受不同手术治疗的24例透析通路动静脉内瘘再狭窄或闭塞患者,其中介入手术10例,开放手术12例,复合手术2例.术后随访3～20个月,平均12个月,评估血流量、狭窄程度、透析时流量及并发症发生情况.结果 24例动静脉内瘘再狭窄或闭塞患者术后透析通路血管搏动及震颤恢复正常,透析流量满意.复查彩色超声均显示狭窄处解除,血液流速恢复.随访期间无再次狭窄或闭塞发生,瘘口流量可满足透析需要;无心功能异常或肢体远端缺血、严重肿胀等并发症发生.结论 不同手术方法治疗动静脉内瘘再狭窄或闭塞效果确切、安全,透析通路长期通畅率良好.     

彩色多普勒超声在监测自体动静脉内瘘中的应用价值

目的探讨彩色多普勒超声对慢性肾功能衰竭患者自体动静脉内瘘的监测作用。方法应用彩色多普勒超声检查41例慢性肾功能衰竭患者动静脉内瘘的功能。结果 41例慢性肾功能衰竭患者17例动静脉内瘘血流通畅,血液透析量达标;24例出现并发症:局部血栓形成未完全闭塞4例(头静脉侧3例,瘘口处1例),完全闭塞9例(瘘口处闭塞7例,头静脉侧闭塞2例),栓塞后再通2例,狭窄6例(瘘口处狭窄5例,流出静脉狭窄1例),假性动脉瘤1例,静脉瘤样扩张2例。根据检查结果,采取相应的临床措施(内瘘重建术,溶栓等)取得满意的效果。结论彩色多普勒超声能够快速、准确地判断慢性肾功能衰竭患者动静脉内瘘的通畅情况,有无并发症,为临床及时治疗提供科学依据。     

超声引导穿刺在动静脉内瘘溶栓治疗中的应用价值分析

血液透析治疗对延长尿毒症患者生存期具有重要的意义,为降低血液透析对患者机体造成的刺激,动静脉内瘘是血液透析患者首选的血管通路,动静脉内瘘畅通对保证血液透析治疗的正常进行具有重要的意义[1]。行动静脉造瘘术患者由于机体纤溶系统稳定性被破坏,动静脉内瘘易出现阻塞,急性动静脉内瘘血栓形成患者需对其实施溶栓治疗。本次研究为论证超声引导穿刺在动静脉内瘘溶栓治疗中的应用价值,选择2016年6月至2019年6月焦作市第二人民医院收治的69例动静脉内瘘阻塞患者进行对照研究,现报告如下。     

Interventional radiology in the treatment of high-flow renal arteriovenous fistulas. Report of two cases

PURPOSE: To describe the morphological and haemodynamic characteristics of high-flow idiopathic renal arteriovenous fistulas and the radiological treatment techniques. MATERIALS AND METHODS: Two cases of idiopathic renal arteriovenous fistula were treated with transcatheter embolization. In the first case, the anomalous arteriovenous communication was embolized with acrylic glue through the afferent artery while the efferent vein was temporarily occluded with a balloon catheter using the "stop flow" technique. In the second case, the fistula was occluded from the arterial side using Gianturco coils and the "free flow" technique. RESULTS: In both cases post-procedural angiography demonstrated occlusion of the fistula. A color-Doppler US examination 6 months later showed the regularization of flow parameters in the renal artery and vein. Angiographic follow-up showed occlusion of the arteriovenous fistula, regularization of the renal artery calibre and normal renal parenchymal flow. CONCLUSIONS: Embolization is the best treatment for rare, high-flow, renal arteriovenous fistulas. The "stop flow" technique with acrylic glue is fast and economical. The "free flow" technique with coils is more expensive and complex, but just as effective.     

肾透析用动静脉内瘘急性血栓置管溶栓的护理

目的总结8例血液透析用动静脉内瘘发生急性血栓,行置管溶栓治疗的护理配合。方法对患者进行局部置管碎栓后,再用尿激酶团注结合微泵持续溶栓。结果患者能积极配合置管溶栓,内瘘均能再通。结论本方法血栓发生时间短,操作简单、不良反应小、效果满意。     

近肾主髂动脉闭塞病变腔内治疗的围手术期护理体会

【摘要】　目的?探讨近肾主髂动脉闭塞病变（JAIOD）患者腔内治疗的围手术期护理。方法?回顾性分析自 2012年1月至2018年12月中国医科大学附属第一医院血管外科收治的22例近肾主髂动脉闭塞行腔内治疗患者的临床资料,入组患者符合腔内治疗适应证,采用双侧股动脉和肱动脉入路,先给予置管溶栓术,溶栓3 d后造影,开通病变,肾动脉预置球囊保护后,行对吻支架植入术。结果?19例患者开通成功,技术成功率为86.4%。无一例患者围手术期死亡。术后患者症状、ABI及疼痛评分较术前均有明显改善（P＜0.01）。所有患者围手术期均给予规范的术前护理,术后护理和出院指导,并着重进行置管溶栓相关护理和术后并发症的观察和护理,及时有效地避免了不良事件的发生。结论?优质的围手术期护理,能够降低患者并发症的发生率,提高患者预后,是需要重视的重要工作。     

腔内介入治疗Cockett综合征伴左下肢深静脉血栓形成

目的 探讨Cockett综合征伴左下肢深静脉血栓形成(DVT)腔内介入治疗的临床效果.方法 回顾性分析2011年1月至2015年1月收治的256例Cockett综合征伴左下肢DVT患者,采用经导管接触溶栓、球囊扩张闭塞/狭窄段或支架植入术治疗,比较治疗前后患肢周径差、远期通畅率.结果 256例Cockett综合征伴左下肢DVT患者中232例(90.6％)血栓完全溶解.24例(9.4％)部分溶解,治疗前后患肢大腿与小腿周径差分别为(7.12±2.15) cm、(4.57±2.81) cm.206例髂静脉重建患者中单纯球囊扩张46例,球囊扩张联合髂静脉支架植入160例;平均随访15个月(9～24个月),单纯球囊扩张患者失访3例,出现髂静脉闭塞26例(60.5％),血栓后综合征(PTS)21例(48.8％),球囊扩张联合支架植入患者失访11例,支架狭窄/闭塞13例(8.7％),PTS 15例(10.1％),两组闭塞/狭窄、PTS差异有统计学意义(P＜0.001).结论 导管接触溶栓、球囊扩张联合支架植入治疗Cockett综合征,具有确切的临床疗效.     

The role of interventional radiology in biliary complications after orthotopic liver transplantation: a single-center experience

This study evaluated interventional radiological experience in the management of biliary complications of OLT at the National Cancer Institute of Milan. Seventeen patients who had undergone orthotopic liver transplantation in various hospital were referred to our unit with biliary complications. Group I consisted of 8 patients with anastomotic biliary fistula who came to our attention a short time after transplantation. Group II consisted of 9 patients with anastomotic strictures who came to our attention in a longer period. Two different interventional radiological approaches were used: (a) percutaneous transhepatic biliary drainage (PTBD) in the presence of fistulas in patients of group I; and (b) percutaneous transhepatic biliary drainage combined with dilatation of the strictures with a balloon catheter in patients of group II. On the whole resolution of the biliary complications was achieved in 13 of the 17 cases treated (76.5%), 5 of 8 in group I and 8 of 9 in group II. No secondary stenosis after PTBD were observed in group I, whereas two patients of group II needed a second dilatation. Percutaneous biliary drainage is indicated as a valid treatment in the management of biliary complications, either to allow closure of the fistula either to perform balloon dilatation of stenosis.     

Transcatheter Thrombolysis with High-Dose Bolus Tissue Plasminogen Activator in Iatrogenic Arterial Occlusion after Femoral Arterial Catheterization

Purpose: To assess the efficacy of percutaneous local thrombolysis with high-dose bolus recombinant tissue plasminogen activator (rt-PA) in patients with acute limb ischemia due to arterial thrombosis after cardiac catheterization. Methods: We treated eight patients (7 men; mean age 56 years) with thrombotic occlusion of both the common femoral artery (CFA) and external iliac artery (EIA) in six patients and of the CFA only in two patients. Two 5 mg boluses of rt-PA were injected into the proximal clot through a 5 Fr end-hole catheter and subsequently two additional boluses of 5 mg rt-PA were given through a catheter with multiple side-holes. In case of a significant amount of residual thrombus, a continuous infusion of 2.5 mg/hr of rt-PA was started. Results: Successful lysis was achieved in all patients. The mean duration of lysis was 2 hr 41 min. The mean total amount of rt-PA delivered was 23.16 mg. In four patients unmasked flow-limited dissections confined to the CFA were managed by prolonged balloon dilatation, while in the remaining four patients with extension of the dissection to the external iliac artery one or two Easy Wallstents were implanted. There was prompt relief of lower limb ischemic symptoms and signs in all patients. Two groin hematomas were conservatively treated. Clinical and color Doppler flow imaging follow-up with a mean duration of 15 months, showed no reappearance of ischemic symptoms or development of restenosis in any of the patients. One patient died 6 months after thrombolysis. Conclusions: Transcatheter thrombolysis with high-dose bolus rt-PA is a safe and effective treatment in patients with iatrogenic arterial occlusion after femoral catheterization. Underlying dissections should be treated by prolonged balloon dilatation but stent implantation is often required.