Fogarty球囊导管治疗血液透析患者动静脉内瘘血管栓塞的远期疗效观察

Objective To observe the long-term clinical effects of Fogarty catheter on arteriovenous fistula thrombosis and reperfusion rate in patients on hemodialysis. Methods The thrombosed vascular access was incised and F4 or F5 Fogarty catheter was inserted. After the Fogarty catheter passed through the thrombus, the heparin saline was infused into the balloon and then the catheter was pulled back. All the patients were followed up for 5-48 months. Results In 14 cases of total 15 patients embolisms were removed successfully and the blood flow during hemodialysis reached more than 200 ml/min. The catheter use time was (21.5±15.4) months in average and the longest use time was 48 months. Conclusions The recent and long-term effects of Fogarty catheter is good for arteriovenous fistula thrombosis, which prolongs the use period of autologous arteriovenous fistula and is worthy to be popularized.     

Fogarty导管在老年内瘘血管栓塞中的应用

进行血液透析治疗的终末期肾衰竭患者首先要解决的问题是血管通路的建立，一条好的血管通路，能够延长患者的生命，减轻患者的痛苦，并能够提高患者的生活质量。老年患者建立自体内瘘的困难较多，而由于患者自身血管条件、血管内膜增生、反复穿刺、吻合口狭窄、低血压等原因造成瘘管流量不足，导致血栓形成是动静脉内瘘（AVF）失效的最主要原因。     

Fogarty导管用于动静脉内瘘成形术31例经验体会

成功建立动静脉内瘘对血液透析效果影响较大,糖尿病、血管硬化和血管纤细的患者动静脉内瘘术失败率较高.我院近3年来对31例前臂血管纤细、血流量差的患者行动静脉内瘘成形术时应用Fogarty导管,取得较好疗效.     

Fograty球囊导管在自体动静脉瘘血栓取栓术中的应用效果观察

目的 观察用Fograty球囊导管行自体动静脉内瘘血栓取栓术的疗效.方法 用Fograty球囊导管行自体动静脉内瘘血栓取栓术58例.结果 患者自体动静脉内瘘血栓均被完全取出,开放血管后血流恢复.49例患者术后内瘘保持畅通至今.9例术后约1 a再次血栓形成,均再次取栓均成功,次日有5例再次形成,2例改行腹膜透析,3例行颈内静脉长期留置管.结论 Fograty球囊导管用于自体动静脉内瘘血栓取栓疗效满意.     

血管内栓塞治疗多发性硬脑膜动静脉瘘一例

患者男,25岁,因"耳鸣伴头痛1年"于2014年6月15日收入首都医科大学宣武医院神经外科。患者于2013年1月15日从高处坠落伤及头部,当时颅内无明显脑挫裂伤及出血。伤后5个月,患者出现耳鸣伴头痛症状,在当地医院以耳部疾病治疗,无明显效果。2014年4月15日患者于当地医院行头部CT,示左侧横窦及上矢状窦均增粗,呈     

维持性血液透析患者发生动静脉内瘘栓塞的危险因素分析

目的 维持性血液透析患者发生动静脉内瘘栓塞的危险因素分析。方法 回顾性分析（2020年1月至2022年2月）我院98例行维持性血液透析患者临床资料,依据是否发生动静脉内瘘栓塞分为栓塞组（n=40）、未栓塞组（n=58）,对比两组临床资料、实验室指标,分析动静脉内瘘栓塞发生的危险因素。结果 两组患者在年龄、合并心脑血管疾病、糖尿病、使用左卡尼汀上对比（P<0.05）;两组患者在性别、使用阿司匹林、叶酸上对比（P>0.05）。两组患者在钙磷乘积、三酰甘油、低密度脂蛋白上对比（P<0.05）;两组在血磷、血红蛋白、总胆固醇、高密度脂蛋白上对比（P>0.05）。经多因素Logistic回归分析,年龄、糖尿病、左卡尼汀使用情况、低密度脂蛋白、钙磷乘积为维持性血液透析患者动静脉内瘘栓塞危险因素（P<0.05）。结论 维持性血液透析动静脉内瘘栓塞与年龄≥60岁、合并糖尿病、未使用左卡尼汀、低密度脂蛋白、钙磷乘积密切相关。     

球囊辅助技术在硬脑膜动静脉瘘栓塞术中的应用

目前,对大部分硬脑膜动静脉瘘(dural arteriovenous fistulas,DAVF)均可以采取血管内栓塞治疗,患者可得到治愈。血管内栓塞已成为各型DAVF的主要治疗手段。随着介入材料的发展,球囊已初步应用于血管内栓塞DAVF的辅助治疗中。当单纯经静脉途径或动脉途径进行栓塞困难或不能达到满意栓塞效果时,我们采用了球囊辅助技术进行栓塞,     

一步法经皮球囊扩张术治疗二尖瓣狭窄中远期疗效观察

目的:观察一步法经皮球囊扩张术治疗严重二尖瓣狭窄的中、远期疗效。方法:回顾分析一步法经皮经房间隔穿刺球囊扩张术治疗风湿性心脏病二尖瓣狭窄的资料。结果:59例经皮二尖瓣狭窄球囊扩张术均获成功,左房平均压从(27.54±7.54)mmHg降至(15.17±5.78)mmHg(P<0.001),经3～7年随访,二尖瓣口面积从(0.92±0.20)cm2增加至(1.63±0.26)cm2(P<0.01),肺动脉收缩压从(45.7±19.54)mmHg降至(36.24±13.21)mmHg(P<0.05),再狭窄率15.3%。结论:一步法经皮球囊扩张术治疗重症二尖瓣狭窄成功率高,中远期疗效好。     

Fogarty导管取栓联合高压球囊腔内成形术在老年血液透析患者自体动静脉内瘘狭窄伴血栓形成中的应用

目的 探讨Fogarty导管取栓联合高压球囊腔内成形术在老年血液透析患者自体动静脉内瘘狭窄伴血栓形成中的应用。方法 选择2018年3月至2019年3月于宜宾市第一人民医院杂交手术室同期行Fogarty导管取栓和高压球囊腔内成形术的老年血液透析患者42例为研究对象,分析其治疗效果、并发症、通畅率及其影响因素。采用SPSS 22.0统计软件进行数据分析。采用Breslow检验对术后内瘘通畅时间影响因素进行单因素分析,Cox风险回归分析对术后内瘘通畅率影响因素进行多因素分析。结果 手术成功率为95.24%(40/42),术后并发症发生率为9.52%(4/42)。手术成功的患者术后1个月通畅率97.5%(39/40),3个月通畅率87.5%(35/40),6个月通畅率72.5%(29/40),12个月通畅率52.5%(21/40),24个月通畅率22.5%(9/40)。单因素分析结果显示:术后吸烟、血糖和血压控制差、残留狭窄、吻合口狭窄及穿刺点狭窄是影响老年患者术后内瘘通畅时间的独立危险因素(均P<0.05)。多因素Cox分析结果显示:术后吸烟、血糖和血压控制差、残留狭窄、吻合口狭窄及穿刺点狭窄是影响老年患者术后内瘘通畅率的独立危险因素(均P<0.05)。结论 Fogarty导管取栓联合高压球囊腔内成形术治疗老年血液透析患者自体动静脉内瘘狭窄伴血栓形成手术成功率高,术后短中期通畅率较高,并发症较少。术后吸烟、血糖或血压控制差、残留狭窄、吻合口狭窄及穿刺点狭窄是影响老年患者术后内瘘通畅率的重要因素。     

应用弹簧栓子栓塞治疗肺动静脉瘘

目的：总结应用弹簧栓子栓塞治疗肺动静脉瘘经验及疗效。方法：肺动静脉瘘19例患,其中囊状肺动静脉瘘12例（单发囊状8例,多发囊状4例）,多发弥漫型肺小动静脉瘘7例。均采用弹簧栓子进行栓塞治疗。结果：18例栓塞成功,11例囊状肺动静脉瘘股动脉平均血氧饱和度由术前88％上升为术后97％,7例多发弥漫型肺小动静脉瘘由术前82％上升为术后93％。1例囊状肺动静脉瘘栓塞失败,2例栓塞时发生一过性胸痛。10例随诊6个月至9年（平均24个月）,3例症状复发,均进行了再次栓塞治疗成功。结论：弹簧栓子栓塞治疗肺动静脉瘘,是安全有效的治疗方法。     

Contemporary management of arteriovenous haemodialysis fistula aneurysms

IntroductionAneurysms develop in up to 60% of patients with an arteriovenous fistula. Frequently arteriovenous fistula aneurysms are asymptomatic with the presence of symptoms potentially heralding the development a significant complication. A range of surgical and endovascular techniques are available to manage arteriovenous fistula aneurysms but clinical guidelines regarding the appropriate application of each approach are lacking. This review will examine the presentation, indications for treatment and management options for arteriovenous fistula aneurysms.MethodsA non-systematic review of published literature in the following databases was performed: Medline, ScienceDirect, Scopus and the Cochrane Database of Systematic Reviews. Publications relating to arteriovenous fistula aneurysms and treatment options between January 1973 and June 2016 were considered for inclusion. Articles pertaining to aneurysms and pseudoaneurysms of prosthetic arteriovenous access sites were excluded. The literature search was supplemented by a review of the author's experience.ResultsArteriovenous fistula aneurysms are defined by an expansion of the intimal, medial and adventitial layers of the vessel wall to a diameter of more than 18 mm. Treatment of arteriovenous fistula aneurysm is indicated if there is pain, risk of haemorrhage and flow disturbance (either low or high flow). When deciding on whether to actively treat or observe, the diameter of the arteriovenous fistula aneurysm and cosmetic concerns should not be considered in isolation. Commonly applied approaches for treating arteriovenous fistula aneurysm are resection with interposition, remodelling and insertion of an endovascular stent graft. Although various surgical and endovascular options have been reported, there are no prospective studies directly comparing techniques.ConclusionsAsymptomatic aneurysms can be safely observed. Due to a lack of sufficient evidence base, no individual management strategy can currently be recommended for aneuryms requiring treatment. Finally, symptomatic aneurysms, mainly which are in the high risk of bleeding, should be indicated for the treatment as soon as possible.     

Diagnosis and management of acute traumatic arteriovenous fistula

Acute arterial injuries are often complicated by the development of an arteriovenous fistula (AVF). In the acute setting, an AVF may present at the same time as the arterial injury. A case of traumatic AVF in the thigh that presented with normal neurovascular examination findings is reported. AVF was diagnosed by duplex scan and managed promptly. The authors suggest that duplex imaging together with arteriography, where appropriate, should be performed routinely when penetrating wounds are in close proximity to major vessels despite a normal clinical neurovascular examination.     

超声诊断创伤性动静脉瘘

目的:探讨彩色多普勒超声在创伤性动静脉瘘诊治中的应用价值。方法:回顾性分析10例创伤性动静脉瘘患者的灰阶和彩色多普勒超声图像,包括动静脉瘘瘘口发生位置、瘘口大小及形态、受累静脉增宽程度、动静脉内血流表现、动静脉瘘分流的血流峰值流速、受累动脉近心端和远心端的血流频谱变化,受累静脉内频谱表现,并与手术结果或磁共振对比。术后检查,注意观察动静脉瘘口是否闭合,瘘口处动静脉的灰阶图像及血流表现。结果:动静脉瘘超声定性诊断率100%(10/10),瘘口位置诊断准确率100%(10/10),血流频谱的特异性表现为瘘口处高速、低阻及双期单向连续性血流,受累静脉内出现动脉样频谱。术后检查瘘口闭合(9/9,100%),原受累静脉内未探及动脉样频谱。结论:多普勒超声诊断动静脉瘘具有无创、简便、易行且准确率较高的优点,并具有较高的临床应用价值。     

Giant renal aneurysm with arteriovenous fistula

A hypertensive 78-year-old woman was admitted with continuous abdominal pain and nausea and was diagnosed with right giant renal artery aneurysm (RAA; 70 mm in diameter) by means of abdominal computed tomography. Aortography demonstrated huge RAA with arteriovenous fistula visualizing the inferior vena cava at arterial phase. Nephrectomy was performed and the patient has had an uneventful postoperative course.     

硬脑膜动静脉瘘分型与治疗方法的关系

目的：探讨硬脑膜动静脉瘘分型与治疗方法的关系。方法：对28例硬脑膜动静脉瘘患者行全脑血管造影；DSA采集速度4～8帧／s，依据Cognard分型分别采用压迫颈动脉(2例)、动脉入路栓塞(8例)、栓塞 手术(10例)及手术(8例)的治疗方法。结果：有10例治愈，12例症状明显改善。4例症状缓解，1例无改善，1例加重。结论：硬脑膜动静脉瘘的治疗比较困难，术前仔细研究病变的血流动力学特点，正确采取不同的方法常能取得较好的疗效。治疗方法的选择与瘘口的位置、供血动脉数量以及静脉引流方式等有关。     

硬脑膜动静脉瘘动物模型的建立

目的观察吻合右侧颈动静脉并闭塞左侧横窦和上矢状窦前部造成颅内静脉窦高压模型后，能否产生硬脑膜动静脉瘘。方法将51只体重为200～250g的SD雄性大鼠随机分成两组：(1)实验组：45只大鼠，接受吻合右侧颈总动脉和颈外静脉并闭塞左侧横窦和上矢状窦前1／3的手术。(2)对照组：6只大鼠，仅解剖颈部血管和硬脑膜窦而不吻合或闭塞。术后90d行全脑血管造影，观察有无动静脉瘘。结果实验组有28只大鼠出现面部动静脉瘘，其中6只出现硬脑膜动静脉瘘，出现率为13．3％。对照组大鼠未见动静脉瘘。结论颈动静脉吻合后合并静脉窦闭塞的大鼠静脉窦高压模型能产生类似临床的硬脑膜动静脉瘘，可以作为研究硬脑膜动静脉瘘的动物模型。     

动静脉内瘘对血液透析患者心脏功能的影响

目的探讨动静脉内瘘对血液透析患者心脏功能的影响。方法对中国医科大学附属第二医院肾内科2004—2005年收治的55例尿毒症血液透析患者于动静脉内瘘术(AVF)前后进行心脏彩色超声心动图检测,对比分析左心房内径(LAD)、左心室内径(LVD)、左室舒张末容积(LVEDV)、左心室每搏输出量(SV)、左心室射血分数(EF)及右心室内径(RVD)指标的变化。结果AVF术后LAD、RVD、LVD、LV-EDV均有不同程度的增大,而EF水平下降,P<0·05有统计学意义;SV有所增加,P>0·05无统计学意义。结论AVF可以造成血液透析患者左心房、心室腔的扩大,左心室的收缩功能下降。