经皮腔内血管成形术治疗血液透析患者的中心或外周静脉狭窄

M. Yaman, M. Sahin, H. Simsek, H. Gumrukcuoglu, M. Tuncer, Y. Gunes, Serkan Akdağ
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摘要

动静脉瘘功能障碍是血液透析患者中常见的外周或中心静脉闭塞性疾病。在治疗中,首选血管内开放手术。我们的研究说明了经皮腔内血管成形术(PTA)治疗这些患者的临床成功。回顾性分析了2年内出现血液透析失败和同侧手臂肿胀并伴有外周和/或中心静脉狭窄的患者。根据临床和血管造影指示行PTA。PTA的技术成功定义为小于30%的残余狭窄,临床成功是通过疼痛和水肿的缓解以及AVF的保存来说明的。我们的研究显示了一个亚组的26名患者表现为有症状的外周或中心静脉闭塞性疾病。平均随访12.4个月(范围3-24个月)。PTA治疗26例成功,其中11例为中心病变,15例为外周病变。我们发现,对于中心病变,PTA在3、6、12个月时的优先通畅率分别为81.8%、60%、37.5%,支持初级通畅率分别为90.9%、70%、62.5%。对于周围病变,3个月、6个月和12个月的原发性通畅率分别为86.7%、78.5%、66.6%,辅助原发性通畅率分别为93.3%、85.7%和75%。在血液透析患者中,PTA治疗中心和外周静脉狭窄是一种成功和安全的手术。对于引起扩张的病变患者,受影响肢体的持续功能通路是持续的,特别是对于周围静脉狭窄的患者。
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Percutaneous transluminal angioplasty in haemodialysis patients with central or peripheral venous stenosis
Dysfunction of arteriovenous fistulae (AVF), which result from peripheral or central venous occlusive illness, occurs very often in haemodialysis patients. In therapy, endovascular open procedures are prefered. Our study illustrated the clinical success of percutaneous transluminal angioplasty (PTA) for the treatment of these patient. A retrospective analysis was applied on patients presenting during a 2-years term with haemodialysis failure and ipsilateral arm swelling coherant with peripheral and/or central venous stenosis. PTA was performed as clinically and angiografically indicated. Technical success of PTA was defined less than 30% residual stenosis and clinical success was illustrated by resolution of pain and edema along with preservation of the AVF. Our study shows a subgroup of 26 patients that presented with symptomatic peripheral or central venous occlusive disease. Mean follow-up was 12.4 months (range, 3-24 months). PTA was successful in 26 patients 11 of whom were with central lesions and 15 of whom were with peripheral lesions. We were stated for central lesions PTA had a priority patency rates of 81.8%, 60%, 37.5% and supported primary patency rates of 90.9%, 70%, 62.5% at 3, 6, 12 months. For peripheral lesions, primary patency rates of 86.7%, 78.5%, 66.6% at 3, 6 and 12 months and assisted primary patency rates of 93.3%, 85.7% and 75%, separately. PTA for central and peripheral venous stenosis is be a successful and safe procedure in hemodialysis patients. In patients with lesions that are responsible for dilation, continuous functional access in the affected extremity is sustained, especially for patients with peripheral venous stenosis.
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