Salvage of immature forearm fistulas for haemodialysis by interventional radiology
Salvage of immature forearm fistulas for haemodialysis by interventional radiology
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DOI：
10.1093/ndt/16.12.2365
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发表时间：
2001-12-01
影响因子：
6.1
通讯作者：
Pengloan, J
中科院分区：
文献类型：
--
作者：
Turmel-Rodrigues, L;Mouton, A;Pengloan, J
背景本文的目的是评估血管内技术在挽救未成熟瘘管中的价值。在6年的时间里，52个功能障碍和17个血栓形成的未成熟前臂瘘（平均年龄10周）进行了介入放射学治疗。通过肱动脉穿刺进行血管造影，但在瘘管插管后进行基础狭窄扩张，尽可能使用直径不小于5 mm的球囊。从未指示和从未进行任何类型静脉的栓塞或结扎。对于血栓形成的瘘管，通过手动导管引导抽吸清除显著凝块。在球囊填塞无法控制的扩张引起的破裂病例中使用覆膜支架（Passager（R））。在100%的病例中诊断出潜在狭窄。其中一半位于吻合区。介入放射学的初次成功率为97%。9例（13%）发生扩张诱导的破裂，但只有2例需要支架。严重临床并发症发生率为2.8%（菌血症、假性动脉瘤）。1年时的一期和二期通畅率分别为39%和79%。respectively.Conclusions.自体瘘管的延迟成熟应导致系统成像，因为所有病例均诊断出潜在狭窄。介入放射学可以治疗大多数病例，并达到97%的成功率，但可能发生狭窄的早期复发。因此，在放射学上挽救瘘管后，必须对患者进行多学科再评估。
Background. The goal of this article is to assess the value of endovascular techniques for the salvage of fistulas that fail to mature.Methods. Over a 6-year period, 52 dysfunctional and 17 thrombosed immature forearm fistulas (mean age 10 weeks) were treated by interventional radiology. Angiography was performed by puncture of the brachial artery but dilation of underlying stenoses was performed after cannulation of the fistula itself, whenever possible, with a balloon never smaller than 5 mm. Embolization or ligation of any type of vein was never indicated and never performed. For thrombosed fistulas, significant clots were removed by manual catheter-directed aspiration. A covered stent (Passager(R)) was used in cases of dilation-induced rupture not controlled by balloon tamponade.Results. An underlying stenosis was diagnosed in 100% of cases. Half of them were located in the anastomotic area. The initial success rate of interventional radiology was 97%. Dilation-induced rupture occurred in nine cases (13%) but stents were necessary in only two cases. The rate of significant clinical complications was 2.8% (bacteraemia, pseudoaneurysm). Primary and secondary patency rates at 1 year were 39 and 79%. respectively.Conclusions. Delayed maturation of native fistulas should lead systematically to imaging as an underlying stenosis is diagnosed in all cases. Interventional radiology can treat the majority of cases and achieve a 97% success rate but early recurrence of stenoses can occur. Multidisciplinary re-evaluation of the patient must, therefore, be performed after radiological salvage of the fistula.