Wang Mao-Qiang, Xie Chun-Ming, Wang Zhong-Pu, Guan Jun, Gu Xiao-Fang, Liu Feng-Yong
Department of Interventional Radiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
Zhonghua Wai Ke Za Zhi. 2004 Jun 7;42(11):687-91.
To evaluate the efficacy and safety of the interventional techniques for treatment of acquired arteriovenous fistulas (AVF).
Ten patients with acquired AVFs, including 4 with renal AVF, 3 with iliac AVF, and 3 with subclavian AVF, were treated with interventional procedures. The etiological factors of the AVFs were penetrating trauma in 5 cases, iatrogenic injury in 3, malignancy in 1, and intestine Crohn's disease in 1. The patients presented with peripheral venous hypertension (n = 6), local bruit (n = 10), cardiac overload (n = 10), the right cardiac failure (n = 2), and hematuria (n = 4). Three patients underwent transcatheter super-selective coils embolization and 7 underwent stent-graft placement in the involved arteries.
The technical success was achieved in all cases. Completion angiography documented complete exclusion of the fistulas. Minor complications occurred in 3 patients, but without significant consequences. The patients experienced immediate relief of the limb swelling, peripheral venous hyperemia, and tachycardia. The local bruit was disappeared. The cardiac overload conditions were improved significantly, which was confirmed by ultrasound scan. Renal function tests in patients with renal AVF were stable. Radioactive isotopic scan revealed that the function was preserved in the treated kidney in two patients using stent-graft placement in the renal arteries. Follow-up time ranged from 6 months to 6 years. Three patients respectively died of unrelated AVF diseases in 6, 9, and 14 months after the treatment. Re-intervention with an another stent-graft placement was performed on 2 patients with recurrence of the AVF respectively at 3 weeks and two months after the procedures. The minor stenosis was found in stent-graft 2 of patients on the follow-up angiography respectively at 6 and 8 months after the treatment. Seven patients are still alive and in good condition without further intervention.
Minimally invasive interventional procedures, including super-selective embolization and stent-graft exclusion, are safe and effective in the treatment of acquired arteriovenous fistulas.
评估介入技术治疗后天性动静脉瘘（AVF）的疗效和安全性。
对10例后天性AVF患者进行介入治疗，其中肾AVF 4例，髂AVF 3例，锁骨下AVF 3例。AVF的病因包括穿透性创伤5例、医源性损伤3例、恶性肿瘤1例、肠道克罗恩病1例。患者表现为外周静脉高压（n = 6）、局部杂音（n = 10）、心脏负荷过重（n = 10）、右心衰竭（n = 2）和血尿（n = 4）。3例患者接受经导管超选择性弹簧圈栓塞，7例患者在受累动脉置入覆膜支架。
所有病例技术均成功。造影显示瘘口完全闭塞。3例患者出现轻微并发症，但无严重后果。患者肢体肿胀、外周静脉充血和心动过速立即缓解。局部杂音消失。心脏负荷过重情况明显改善，超声检查证实。肾AVF患者的肾功能检查稳定。放射性同位素扫描显示，2例在肾动脉置入覆膜支架的患者，治疗后的肾脏功能得以保留。随访时间为6个月至6年。3例患者分别在治疗后6、9和14个月死于与AVF无关的疾病。2例AVF复发患者分别在术后3周和2个月再次置入覆膜支架。治疗后6个月和8个月的随访血管造影分别显示2例患者的覆膜支架有轻微狭窄。7例患者仍存活，情况良好，无需进一步干预。
包括超选择性栓塞和覆膜支架封堵在内的微创介入治疗后天性动静脉瘘安全有效。
