Marks Natalie, Ascher Enrico, Hingorani Anil P
Maimonides Medical Center, Division of Vascular Surgery, Brooklyn, New York 11219, USA.
Perspect Vasc Surg Endovasc Ther. 2007 Mar;19(1):50-5. doi: 10.1177/1531003506298144.
Diagnostic arteriography and balloon angioplasty of failing or nonmaturing arterio-venous (AV) access is based upon using nephrotoxic contrast. Patients not yet on dialysis with borderline renal function with nonmaturing AV accesses or ones with an allergy to contrast media present a therapeutic challenge. We have used duplex scanning as an alternative imaging modality to guide endovascular therapy in 10 cases (9 autologous and 1 prosthetic). Six target AV accesses (60%) were used for dialysis. Number of stenoses ranged from 1 to 5 per AV access. Short access sheath insertion, wire and balloon passage, and inflation were guided by duplex only. Balloon size (5-8 mm in diameter) was chosen based on duplex measurements. Cutting balloons (4 x 20 mm and 5 x 20 mm) were used for dilatation of recoiling lesions in 4 cases. One patient had a self-expanding stent placed under duplex-guidance for recoiling lesion in the junction of the brachial and axillary veins. Angioplasty of failing AV access can be performed under duplex guidance alone. Duplex guidance offers very important advantages of hemodynamic evaluation for recoiling lesions and need for stenting. Avoidance of contrast use for repair of nonfunctioning AV access can be a useful option in patients with renal failure not yet on dialysis or in cases of allergy.
对于功能衰竭或未成熟的动静脉（AV）通路进行诊断性血管造影和球囊血管成形术时，使用的是具有肾毒性的造影剂。对于尚未接受透析、肾功能处于临界状态且AV通路未成熟的患者，或对造影剂过敏的患者而言，这是一个治疗难题。我们已将双功超声扫描作为一种替代成像方式，用于指导10例患者（9例自体通路和1例人工血管通路）的血管内治疗。其中6条目标AV通路（60%）用于透析。每条AV通路的狭窄数量为1至5处。仅在双功超声的引导下进行短通路鞘管插入、导丝和球囊通过以及球囊充盈操作。根据双功超声测量结果选择球囊尺寸（直径5 - 8毫米）。4例患者使用切割球囊（4×20毫米和5×20毫米）扩张回缩性病变。1例患者在双功超声引导下植入自膨式支架，用于治疗肱静脉和腋静脉交界处的回缩性病变。功能衰竭的AV通路血管成形术可仅在双功超声引导下进行。双功超声引导为评估回缩性病变的血流动力学以及是否需要置入支架提供了非常重要的优势。对于尚未接受透析的肾衰竭患者或存在过敏情况的患者，避免使用造影剂来修复无功能的AV通路可能是一种有用的选择。
