超声引导下经皮腔内血管成形术在血液透析患者动静脉内瘘狭窄中的应用

  目的  探讨维持血液透析患者自体动静脉内瘘狭窄行经皮腔内血管成形术的应用。  方法  对2018年1月~2019年12月在本院进行血液透析并发动静脉内瘘狭窄的40例患者的临床资料进行回顾性分析，所有患者均在术前采用超声评估血管，术中采用超声指导经皮腔内血管成形术治疗，统计手术技术成功率、临床成功率、并发症发生情况，比较手术前后患者的血流指标。  结果  介入超声可清晰显示狭窄部位，引导内瘘狭窄行球囊扩张手术进程。经皮腔内血管成形术后彩超显示40例患者血管狭窄及血栓消失，治疗技术成功率100%，临床成功率100%。仅2例患者出现穿刺点皮下轻度血肿，所有患者均无严重并发症发生。术后动静脉内瘘狭窄处内径、透析血流量、内瘘血流量均较术前明显增加（P < 0.05）。  结论  超声引导下内瘘狭窄行腔内血管成形术具有较高的成功率及开通率，可作为一种安全有效的引导方法，具有一定的临床应用价值。 

Application of ultrasound guided percutaneous transluminal angioplasty on arteriovenous fistula stenosis in hemodialysis patients

  Objective  To investigate the application of ultrasound guided percutaneous transluminal angioplasty on arteriovenous fistula stenosis in maintenance hemodialysis patients.  Methods  The clinical data of 40 maintenance hemodialysis patients with arteriovenous fistula stenosis in our hospital from January 2018 to December 2019 were retrospectively analyzed. All patients accepted blood vessels assessment by ultrasound before operation, and underwent percutaneous transluminal angioplasty under ultrasound intervention guidance during operation. The technical success rate, clinical success rate and occurrence of complications were recorded, and the blood flow parameters before and after operation were compared.  Results  Ultrasound could clearly display the stenosis location, and guide the process of balloon dilatation for arteriovenous fistula stenosis. After percutaneous transluminal angioplasty, the color ultrasound showed that the stenosis and thrombosis disappeared in 40 patients, and both the technical success rate and clinical success rate were 100%. Only 2 cases had mild subcutaneous hematoma at the puncture site, and no serious complications occurred in all patients. The vessel diamete, hemodialysis blood flow and internal fistula blood flow of patients after operation were significantly higher than those before operation (P < 0.05).  Conclusion  Ultrasound guided percutaneous transluminal angioplasty has high success rate and vascular patency rate for arteriovenous fistula stenosis. Ultrasound can be used as a safe and effective guidance method, and is of certain clinical application value.