上臂贵要静脉转位内瘘及前臂人工血管内瘘在血液透析患者应用效果的比较

目的 比较上臂贵要静脉转位内瘘(brachio-basilic transposition arteriovenous fistula,BBTAVF)及前臂人工血管内瘘在血液透析患者的应用效果。方法 回顾性分析首都医科大学附属北京同仁医院2017年1月至2020年1月行BBT-AVF患者(45例)及以贵要静脉为流出道建立人工血管(brachio-basilic arteriovenous graft,BAVG)患者(64例)的临床资料,比较术后36个月的生存率、通路通畅率及手术相关并发症等结果。结果 BBT-AVF组及BAVG组在术后12、24、36个月生存率分别为100%、95.6%、95.6%和98.4%、93.8%、81.3%,差异有统计学意义(P=0.032);术后12、24、36个月的一期通畅率分别为83.4%、70.1%、63.1%和46.9%、14.9%、5.0%,二期通畅率分别为95.2%、89.6%、86.1%和84.4%、65.0%、44.5%,差异有统计学意义(P<0.001)。两组患者在随访期间内30 d急性血栓、假性动脉瘤、中心静脉狭窄、感染及窃血综合征...     

腔内人工血管内支撑术治疗髂动静脉瘘

动静脉瘘是血管外科领域中较为少见的疾病 ,由于它对血流动力学干扰大 ,可引起心脏负荷过重而使心功能失代偿 ,同时瘘口远端组织因动脉血异常分流而产生缺血症状。以往都采用外科手术治疗。在腔内血管外科技术不断发展的基础上 ,我院在国内首次采用腔内人工血管内支撑术治疗髂动静脉瘘。现报告如下。资料与方法1.临床资料 :患者女性 33岁 ,因发现腹部搏动性肿块伴震颤、左足发凉 6个月入院。 5年前因腰椎间盘突出行椎间盘摘除术。体检 :脉搏 10 8次 /ｍｉｎ ,血压 135 /75ｍｍＨｇ。脐下偏左可触及 4ｃｍ× 3ｃｍ搏动性肿块伴震颤 ,可闻及连…     

血液透析患者人工血管移植物内瘘功能障碍的影响因素分析

目的:探讨血液透析（hemodialysis,HD）患者人工血管移植物内瘘（arteriovenous graft,AVG）功能障碍的影响因素,为预测风险、延长使用时间提供依据。方法:回顾性分析南方医科大学南方医院血管与介入科2013年1月至2018年9月期间行AVG建立手术患者的临床与随访资料,通过统计学方法分析AV...     

人工血管动静脉内瘘静脉端不同吻合方式的应用效果比较

目的 比较人工血管动静脉内瘘静脉端不同吻合方式的临床应用效果及预后。方法 回顾性分析2021年1月至2021年12月惠州市第一人民医院行人工血管动静脉内瘘成形术的96例患者临床资料。根据人工血管静脉端吻合方式,分为端端吻合组(49例)和端侧吻合组(47例),比较两组术后相关临床指标和并发症发生情况。结果 术后6周,端端吻合组的内瘘血流量高于端侧吻合组[(697±188) ml/min vs (601±154) ml/min],差异有统计学意义(P=0.014)。术后6个月,端端吻合组和端侧吻合组的初级通畅率(89.80%vs 89.36%)、辅助初级通畅率(93.88%vs 93.61%)、次级通畅率(97.95%vs 97.87%)和尿素清除指数(1.28±0.22 vs 1.31±0.17)差异均无统计学意义(P>0.05)。术后12个月,端端吻合组的初级通畅率(65.31%vs 55.31%)和次级通畅率(91.83%vs 82.98%)显著高于端侧吻合组(P<0.05),辅助初级通畅率(79.59%vs 74.47%)和尿素清除指数(1.33±0.16 vs 1.35±0.13)差异无统计学意义(P>0.05)。端端吻合组并发症发生率为46.93%,端侧吻合组为65.96%,差异有统计学意义(P=0.002)。结论 人工血管动静脉内瘘采用端端吻合方式时,内瘘血流量更大、通畅率更高、术后并发症发生率更低,临床应用效果及预后更佳。     

应用Rotarex?S系统经皮血栓切除治疗人工血管动静脉瘘血栓2例报道并文献复习

背景与目的:人工血管动静脉瘘(AVG)血栓处理目前尚无公认最佳的方法,近年来血管腔内血栓减容逐渐取代开放性手术。本文对应用Rotarex~?S系统切除AVG血栓的病例资料进行总结和分析,探讨Rotarex~?S系统治疗AVG血栓的可行性及安全性。方法:回顾性分析应用机械性血栓切除系统治疗的2例临床资料,结合国内外文献,总结该系统应用于AVG血栓的一些经验。结果:该2例患者手术均获成功,术后6个月均无血栓发生,初次通畅率100%。患者1在术后8个月因动脉吻合口、静脉流出道严重狭窄导致血栓形成,高压球囊扩张后流出道狭窄难以解除,改行对侧上肢AVG新建,目前随访3个月新建AVG通畅;患者2于术后7个月因流量下降再次行静脉吻合口狭窄球囊扩张,术后随访5个月无血栓事件。结论:Rotarex~?S经皮血栓切除系统治疗AVG血栓的治疗拥有快速、高效、安全的优点,可应用于AVG内急性、亚急性血栓,溶栓及吻合口损伤高风险的患者。     

即穿型人工血管在血液透析通路中的应用与长期疗效分析

目的 分析单中心即穿型人工血管应用于血液透析通路的36个月长期疗效。方法 回顾性分析上海交通大学医学院附属仁济医院自2018年1月至2019年12月收治的采用即穿型人工血管建立的移植物动静脉内瘘(AVG)病人的临床资料,搜集病人的基线资料、术中情况、术后穿刺时间、术后并发症及通畅率情况,根据病人的超声随访,分为规律随访组与未规律随访组,比较两组的通畅率。结果 总共有75例病人纳入研究,其中男性39例,女性36例,平均年龄为(60.1±15.8)岁,平均术后首次穿刺时间为(3.3±2.2)d。平均随访时间为(39.2±8.5)个月,术后12个月、24个月、36个月的一期通畅率分别为62.7%、40.0%、21.3%,一期辅助通畅率分别为77.3%、50.7%、33.3%,二期通畅率分别为94.7%、90.7%、89.3%。规律随访组的一期辅助通畅率显著高于未规律随访组(P值分别为0.026、0.027和0.008)。结论 即穿型AVG的长期通畅率结果满意,规律超声随访可以有效提高术后一期辅助通畅率,减少急性血栓形成。     

维持性血液透析患者动静脉内瘘术后7天内血栓的处理

目的：探讨动静脉内瘘术后7d内血栓形成的处理。方法：术中立即形成血栓者可以柔性挤压瘘口,特别是近心端动脉侧,直至内瘘通畅。手术成功后已缝合内瘘皮肤再出现血栓者,可以打开皮肤切口,松解内瘘周围,柔性挤压瘘口,必要时向瘘口推注肝素钠注射液。结果：41例动静脉内瘘术后7d内血栓形成患者,经上述处理,36例血栓再通,成功率达87.8%,5例患者处理后内瘘仍堵塞未通,另行动静脉内瘘手术。结论：动静脉内瘘术后7d内血栓形成患者,早期处理是关键,术后抗凝,扩血管药物治疗很重要。     

下肢和上肢人工血管动静脉内瘘的临床应用效果比较

目的 比较血液透析患者下肢与上肢人工血管动静脉内瘘的术后通畅率、透析充分性及并发症的情况,为临床上建立下肢人工血管动静脉内瘘提供参考.方法 回顾性分析2015年4月至2020年4月在山东第一医科大学附属济南市中心医院肾脏病/血液净化科行下肢和上肢人工血管动静脉内瘘手术的47例患者的资料.结果 成功纳入患者47例(下肢1...     

维持性血液透析患者应用人造血管内瘘的护理

血液透析是目前慢性肾衰竭的主要治疗措施之一，建立良好的血管通路是长期维持性血液透析得以顺利实施的首要条件，对透析效果和长期存活有重要影响。所以动静脉内瘘是维持性血液透析患者的生命线。然而，随着尿毒症患者的高龄化和血管疾病的增多，部分患者由于血管弹性差，静脉纤细、缺短、闭塞及脆性增强等因素。难以建立理想的自体血管内瘘。故需进行人造血管移植建立动静脉内瘘。     

人造血管内瘘术在血液透析中的应用

有效的血管通路是血透患者的生命线.有部分患者因为年龄大、血管条件差等因素,不能成功地建立自体动静脉内瘘,此时,人造血管内瘘就成为较好的选择.近年我院应用聚四氟乙烯(PTFE)为3例尿毒症患者行人造血管造瘘术,现报告如下.     

Outcomes of endovascular salvage of clotted arteriovenous access and predictors of patency after thrombectomy

ObjectiveThis study aimed to report the outcomes of endovascular salvage of clotted arteriovenous (AV) accesses and to determine potential predictors of poor patency rates after thrombectomy.MethodsRecords of hemodialysis patients who underwent endovascular salvage of clotted AV access were reviewed retrospectively. Technical and clinical success rates, complication rates, and 3- and 6-month patency rates were determined. Multivariate analysis was performed to determine the predictors of patency after thrombectomy.ResultsA total of 294 patients underwent endovascular salvage of clotted AV access during the study period; 156 patients had arteriovenous fistula, whereas the remaining 138 were arteriovenous grafts (AVGs). The technical and clinical success rates were 96.3% and 93.2%; the major and minor complication rates were 0.7% and 9.9%. Post-thrombectomy primary, assisted primary, and secondary patency rates were 62.9%, 76.2%, and 77.6% at 3 months and 43.9%, 59.5%, and 61.6% at 6 months. The patency rates were significantly better for arteriovenous fistula than for AVG except for 6-month assisted primary and secondary patency. Multivariate Cox regression analysis showed that prior thrombosis within 90 days was significantly associated with loss of primary patency (hazard ratio [HR], 1.90; 95% confidence interval [CI], 1.21-2.98; P < .01), assisted primary patency (HR, 2.42; 95% CI, 1.42-4.13; P < .01), and secondary patency (HR, 2.52; 95% CI, 1.40-4.53; P < .01). Having an AVG was also negatively associated with primary patency.ConclusionsMost clotted AV accesses can be salvaged by endovascular technique. Recurrent thrombosis within 90 days is associated with poor short- and long-term patency even after successful endovascular reinterventions.     

留置针溶栓处理人工血管动静脉内瘘血栓形成的临床疗效

目的探讨采用留置针溶栓治疗AVG血栓形成的临床疗效。方法回顾性分析佛山市第一人民医院血管外科2018年3~12月行留置针溶栓治疗31例AVG血栓形成患者的临床资料,统计AVG复通的成功率、溶栓时间及并发症等情况。结果 31例患者平均溶栓次数1.5次(1~3次),23例溶栓成功,8例溶栓失败,溶栓成功率74.2%。需置入临时透析管12例,免于置入临时透析管19例(61.3%)。7例患者(22.6%)出血,未见肺栓塞病例。术中球囊扩张处理28例患者,其中支架植入4例。结论留置针溶栓处理急性AVG血栓成功率较高,可减少置管造成的血管损伤,值得在基层医院推广。     

肾动静脉瘘的腔内治疗

目的评估腔内治疗肾动静脉瘘(RAVF)的安全性及有效性。方法回顾性分析13例接受腔内治疗的RAVF患者资料。结果对13例RAVF患者行腔内治疗的技术成功率为100%(13/13),栓塞病变动脉共23条,治疗应用弹簧圈共78个。腔内治疗对RAVF患者血尿的有效率为100%(11/11),腰部疼痛有效率为85.71%(6/7),高血压有效率为100%(3/3)。RAVF患者术前血肌酐平均值[(94.50±29.82)μmol/L]与术后血肌酐平均值[(94.25±28.85)μmol/L]差异无统计学意义(P0.05)。术后无严重并发症,仅3例出现低热,2例患侧腰部不适。术后平均随访(37.23±16.78)个月。2例失访,余11例患者均无复发症状。结论腔内治疗对RAVF患者安全、有效且并发症较少。     

血管腔内治疗慢性下肢缺血时的溶栓治疗

目的 探讨导管溶栓在慢性下肢缺血腔内成形治疗时的可行性、疗效及安全性.方法 回顾性分析2009年2月～2011年2月在广州市中医院接受治疗的11例慢性下肢缺血(TASC Ⅱ D级)患者的临床资料.采用尿激酶(UK)溶栓,然后再行血管腔内治疗,对治疗后临床疗效及动脉通畅率进行统计分析.结果 9例患者(81.8％)血管成形技术获得成功,无并发症发生;2例(18.2％)未溶栓成功.8例患者获得随访,随访率为88.9％,平均随访时间14.5个月.术后1年一期通畅率、辅助一期通畅率和二期通畅率分别为80％、88％及92％,2年为67％、84％及88％.结论 对慢性下肢缺血TASC Ⅱ D级病变进行血管腔内成形时的溶栓是可行、安全且有效的.     

血液透析患者自体动静脉内瘘功能丧失的治疗进展

自体动静脉内瘘(AVF)是维持性血液透析患者最常用的血管通路,其功能完好是血液透析顺利进行的保证。然而在透析过程中常因血栓形成、狭窄等原因导致内瘘丧失功能,如何保持AVF通畅成为临床亟需解决的问题。本文就AVF功能丧失的治疗进展进行综述。     

Local thrombolysis in the treatment of thrombosed arteries, bypass grafts, and arteriovenous fistulas

We reviewed the results, systemic effects, and complications associated with the selective infusion of low-dose streptokinase in 151 patients. Successful thrombus lysis was achieved in 78% of atherosclerotic thrombotic occlusions less than 30 days old, in 81% of post-procedural occlusions less than 14 days old, and in 87% of patients with thrombosed arteriovenous fistulas no more than 4 days old. During the first 12 hours of treatment 81% to 84% of patients had greater than 50% decrease in plasma fibrinogen levels and 100% showed the same decline after 24 hours of treatment. The thrombin time was prolonged to at least 1 1/2 times the control thrombin time in 33% to 42% of patients measured at 4 hours of therapy and in 93% to 97% of patients measured at 24 hours of treatment. Fifteen patients (9.9%) had major complications. Eleven of these had hemorrhagic complications, two had significant distal emboli, one had a thrombosed brachial artery, and one had a false aneurysm at the catheter entry site. We have found that selective low-dose streptokinase is effective in the treatment of acute and chronic thrombotic occlusions and is a useful adjuvant to vascular reconstruction or percutaneous transluminal angioplasty. Although the local infusion dose is substantially lower than the usual systemic dose, a systemic lytic effect was seen in all patients. Hemorrhagic complications occurred despite customary precautions.     

Infectious complications of prosthetic arteriovenous grafts for hemodialysis: prevention is better than cure

Synthetic arteriovenous grafts for hemodialysis constitute the second choice in comparison with native arteriovenous fistulas. Lower patency rates and significantly more frequent infections are the main disadvantages of hemodialysis grafts over fistulas. Infectious complications could vary between a simple local erythema at a puncture site that resolves easily with antibiotics to septicemia and death. As a corollary, this kind of complications continue to be among the most important causes of morbidity and mortality in end-stage renal disease patients receiving long-term hemodialysis. The cornerstone is prevention of infections. It is generally accepted that following simple measures during the intervention of graft insertion and consecutively in every hemodialysis session could consistently reduce the risk of infection.     

先天性动静脉畸形的新分期与治疗选择

目的 探讨颅外先天性动静脉畸形的临床分类方法及相应的治疗选择。方法 通过对6年内83个病例的临床表现、影像诊断、介入治疗、外科手术治疗结果的系统随访和分析，探讨该疾病的临床分期，解剖区域分布规律、各分期的治疗选择、不同介入材料对复发率的影响、进行未痊愈病例原因分析。结果 根据临床表现可将先天性动静脉畸形分为静止期、扩张期和失代偿期，前者以单纯介入治疗为主，后者以手术治疗为主，介入治疗的方法与材料选择对复发率等有重要影响，未栓塞病例的手术治疗要求依据DSA和CTA完整切除和具有丰富血供的组织移植重建。结论 对先天性动静脉畸形的临床分期和合理的治疗方案设计将使此类疑难病例的治疗大大易化。     

Percutaneous thrombolysis of thrombosed haemodialysis access grafts: comparison of three mechanical devices.

BACKGROUND: Percutaneous thrombolysis has become an accepted treatment of thrombosed haemodialysis grafts. Several devices have been developed for mechanical thrombolysis, which macerate the clot using different mechanisms such as aspiration and fragmentation. The aim of our study was to compare the efficacy of three devices for mechanical thrombolysis in removing the thrombus from thrombosed haemodialysis access grafts and to determine the initial technical and clinical success, complication rates of each device, and graft patency after the procedure. METHODS: Thrombolysis (i.e. clot removal followed by percutaneous transluminal angioplasty (PTA)) was performed in 68 thrombosed haemodialysis grafts using the Cragg brush catheter combined with urokinase in 13, the Hydrolyser in 18 and the Arrow-Trerotola Percutaneous Thrombolytic Device (PTD) in 37. Clot removal scores (CRS, the ability to thoroughly remove clot from the access), initial technical success, clinical success, patency at 30, 60, and 90 days, and complication rates were evaluated. RESULTS: CRS for the Cragg brush, Hydrolyser and PTD were good in 92, 44, and 95% of cases, respectively. Initial technical (85, 83, and 95%) and clinical success (62, 67, and 86%), mean patency rates at 30 (73, 60, and 55%), 60 (61, 53, and 49%), and 90 (49, 40, and 43%) days, stenosis after PTA (33, 46, and 21%) and complication rates (8, 6, and 0%) were not different for the three devices. Success rates and graft patency depended on the effect of PTA, irrespective of the device used. CONCLUSIONS: The rotational devices removed clots more effectively than the Hydrolyser, with the PTD having the advantage of not requiring urokinase. However, the result of PTA in the treatment of underlying stenoses was the only predictive value for graft patency.     

血管腔内移植物治疗大动脉疾病的探讨

目的探讨以血管腔内移植物为主的血管腔内疗法治疗胸或胸腹主动脉疾病的疗效和存在问题。方法治疗包括夹层动脉瘤、真性和假性胸主动脉瘤、主动脉减速伤和缩窄患者共137例。主要病变的最低部位在腹腔动脉和肠系膜动脉之间。除血管腔内治疗法外,尚辅以腹主或髂动脉-肠系膜上动脉、或腋动脉-左颈总动脉等架桥术。结果发生急性内脏动脉缺血而急症开腹手术2例。早期漏7例。围手术期死亡6例(4．4％)。随访1～43(平均11)个月,发现后期内漏2例、血管腔内移植物部分断裂1例。DeBakeym型夹层治疗后发生Ⅰ型夹层病变1例。后期死亡5例(4例与腔内移植物无关,1例为多发性动脉瘤复发),失访11例,115例存活。结论以血管腔内移植物治疗高风险的大动脉病变相对安全有效,具有发展前景;但器材有待改进、远期疗效有待观察。