Guerra Alexandra, Raynaud Alain, Beyssen Bernard, Pagny Jean-Yves, Sapoval Marc, Angel Claude
Department of Cardiovascular Radiology, Clinique Alleray Labrouste, 64 Rue Labrouste, F-75015 Paris, France.
Nephrol Dial Transplant. 2002 May;17(5):843-51. doi: 10.1093/ndt/17.5.843.
The purpose of this study was to evaluate retrospectively the clinical context and effectiveness of arterial percutaneous transluminal angioplasty (PTA) of arterio-venous fistulae in chronic haemodialysis patients.
Between May 1992 and June 1997, arterial PTA was performed in 33 patients with a total of 35 angioaccess devices of the upper limbs (18 arterio-venous fistulae and 17 PTFE grafts). Clinical indications for arterial PTA were unexplained acute thrombosis in 12 patients (34.3%), insufficient blood flow in 13 patients (37.1%), and severe limb ischaemia in 10 patients (28.6%), two of whom had skin ulcerations and one had severe neurological damage. Follow-up periods varied between 1 and 55 months (mean 15.5 months).
PTA was attempted in 22 radial, 10 brachial and seven ulnar arteries. Angioplasty was successful (i.e. residual stenosis of </=30%) in all but one patient. There were no complications. Early re-thrombosis (<1 month) occurred in two of the 12 patients with acute occlusions. All the angioaccesses of patients with insufficient blood flow were improved. Eight of the patients with limb ischaemia became symptom free, and two were failures (one had partial healing of skin ulcerations and one did not improve). Re-stenosis occurred in six cases (27.3% of the 22 angiograms performed) but re-dilatation was performed in only two instances. Primary and secondary patencies were 63.5 and 90.6% at 6 months and 40.8 and 75.6% at 24 months, respectively.
Chronic arterial lesions in upper limbs bearing vascular access devices for haemodialysis may lead to thrombosis, ischaemia and insufficient flow for dialysis treatment. PTA is a safe and effective technique with a low rate of re-intervention.
本研究旨在回顾性评估慢性血液透析患者动静脉内瘘动脉经皮腔内血管成形术（PTA）的临床情况及有效性。
1992年5月至1997年6月期间，对33例患者共35个上肢血管通路装置进行了动脉PTA（其中18个动静脉内瘘和17个聚四氟乙烯移植物）。动脉PTA的临床指征包括：12例患者（34.3%）出现不明原因的急性血栓形成，13例患者（37.1%）血流量不足，10例患者（28.6%）出现严重肢体缺血，其中2例有皮肤溃疡，1例有严重神经损伤。随访时间为1至55个月（平均15.5个月）。
对22条桡动脉、10条肱动脉和7条尺动脉进行了PTA尝试。除1例患者外，血管成形术均成功（即残余狭窄≤30%）。无并发症发生。12例急性闭塞患者中有2例发生早期再血栓形成（<1个月）。所有血流量不足患者的血管通路均得到改善。8例肢体缺血患者症状消失，2例治疗失败（1例皮肤溃疡部分愈合，1例无改善）。6例发生再狭窄（占所做22次血管造影的27.3%），但仅2例进行了再次扩张。6个月时的初级和次级通畅率分别为63.5%和90.6%，24个月时分别为40.8%和75.6%。
携带血液透析血管通路装置的上肢慢性动脉病变可能导致血栓形成、缺血及透析治疗血流量不足。PTA是一种安全有效的技术，再次干预率较低。
