介入手术联合口服培哚普利治疗血液透析患者动静脉瘘功能不良的疗效

目的 探讨经皮血管成形术(percutaneous transluminal angioplasty,PTA)治疗血液透析动静脉内瘘狭窄的有效性,比较介入手术后联合培哚普利对再次狭窄率的影响.方法 对17例自体血管动静脉内瘘狭窄患者行血管造影,其中15例行PTA.7例患者PTA术后每日口服培哚普利8 mg,7例患者未服用任何血管紧张素转换酶抑制剂(angiotensin converting enzyme inhibitor,ACEI)和血管紧张素Ⅱ受体拮抗剂(angiotensin receptor blocker,ARB).术后对患者进行随访,观察球囊扩张术的并发症、技术成功率、临床成功率和半年通畅率.结果 17例患者均在动静脉内瘘成熟并使用3个月以上发生功能不良,造影见狭窄多位于动静脉吻合口附近及头静脉透析用穿刺段.经PTA治疗后,造影显示狭窄段血管扩张、再通,治疗技术成功率达86.7％ (13/15),临床成功率达93.3％(14/15).2例患者因为导丝无法通过近乎闭塞段血管而选择其他手术方式.穿刺部位血肿2例,无医源性血管破裂,无继发血栓形成.随访6个月,14例获得临床成功的患者内瘘半年通畅率为64.3％,其中培哚普利组发生再次狭窄1例,对照组发生再次狭窄4例.结论 PTA是治疗动静脉内瘘狭窄安全、有效及微创的方法,联合口服培哚普利可能有助于降低术后再次狭窄率.

Interventional techniques combined with oral perindopril in the treatment of arteriovenous fistula malfunction in hemodialysis patients

Objective To investigate the effect of percutaneous transluminal angioplasty (PTA) in native arteriovenous fistula stenosis in hemodialysis patients,and evaluate the effect of perindopril in restenosis after interventional surgery.Methods Angiography was performed in 17 patients with stenosis of native arteriovenous fistula,15 of whom received PTA treatment.Seven patients received oral perindopril (8 mgdaily) after PTA,but 7 other patients did not take any angiotensin-converting enzyme inhibitor (ACEI) or angiotensin Ⅱ receptor antagonist (ARB).The complications of balloon dilatation,technical success rate,chnical success rate and fistula patency rate for six months of the follow-up were observed.Results All the 17 patients suffered from the dysfunction of arteriovenous fistula after its maturation and successful use for more than 3 months.The angiographic stenosis was found more commonly near the arteriovenous anastomosis and in the puncture section of cephalic vein.After PTA treatment,the angiography showed dilation and recanalization of stenotic segments.The technical success rate was 86.7％ (13/15),and the clinical success rate was 93.3％ (14/15).Two patients did not undergo PTA,because of the fact that the guidewire could not pass through the nearly occluded segment of the vessel.There were 2 cases of hematoma in the puncture site,no iatrogenic vascular rupture or secondary thrombosis occurred.The 14 patients with clinical success were followed up for 6 months,and the fistula patency rate for six months was 64.3％.Only 1 patient suffered from arteriovenous fistula restenosis in the perindopril group,but this situation occurred in 4 cases of the control group.Conclusions PTA could be a safe,effective and minimally invasive method for the treatment of arteriovenous fistula stenosis,and oral perindopril may reduce the postoperative restenosis rate.