Kawarada Osami, Yokoi Yoshiaki, Nakata Shinji, Morioka Nobuyuki, Takemoto Kazushi
Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada City, Osaka, Japan.
Catheter Cardiovasc Interv. 2006 Oct;68(4):513-20. doi: 10.1002/ccd.20751.
The native radiocephalic (Brescia-Cimino) fistula is usually constructed with an anastomosis of the cephalic vein and radial artery. Catheter interventions for native fistula failure have until now been performed via the transcephalic or transbrachial approach. Transradial intervention for native fistula failure was prospectively evaluated for a selected consecutive 11 patients. Six patients had a single lesion and 5 patients had double lesions. Twelve lesions were stenotic and 4 were occlusive with thrombus. Balloon angioplasty alone was successful in 10 lesions. In thrombosed fistulas, 2 lesions underwent manual catheter-directed thrombo-aspiration and 2 further lesions underwent a combination of catheter-directed thrombo-aspiration and mechanical thrombectomy. Cutting Balloon angioplasty was performed for 3 resistant venous stenoses and for 1 radial artery stenosis. Technical and clinical success were achieved in all patients. No vessel rupture or perforation was observed in this study, nor was distal embolization in the radial artery or symptomatic pulmonary embolism. No radial artery occlusion or fistula infection was seen during the follow-up. The primary patency rates were 82% at 3 months and 64% at 6 months. Transradial intervention for native fistula failure is considered safe and feasible in a selected population; yet requires further validation.
自体桡动脉-头静脉（布雷西亚-奇米诺）内瘘通常通过头静脉与桡动脉吻合构建。迄今为止，针对自体内瘘失功的导管介入治疗一直通过经头静脉或经肱动脉途径进行。对连续入选的11例患者前瞻性评估经桡动脉介入治疗自体内瘘失功的情况。6例患者有单个病变，5例患者有两个病变。12个病变为狭窄，4个病变为血栓闭塞。单纯球囊血管成形术在10个病变中成功。在血栓形成的内瘘中，2个病变接受了手动导管引导下的血栓抽吸，另外2个病变接受了导管引导下血栓抽吸与机械性血栓切除术联合治疗。对3个难治性静脉狭窄和1个桡动脉狭窄进行了切割球囊血管成形术。所有患者均获得技术和临床成功。本研究中未观察到血管破裂或穿孔，也未发生桡动脉远端栓塞或症状性肺栓塞。随访期间未见到桡动脉闭塞或内瘘感染。3个月时的主要通畅率为82%，6个月时为64%。经桡动脉介入治疗自体内瘘失功在特定人群中被认为是安全可行的；但仍需要进一步验证。
