Bacchini G, La Milia V, Andrulli S, Locatelli F
Department of Nephrology and Dialysis, A. Manzoni Hospital, Lecco, Italy.
J Vasc Access. 2007 Apr-Jun;8(2):81-5.
Percutaneous transluminal angioplasty (PTA) is a possible treatment for stenosis. This study aimed to verify the impact of a vascular access (VA) surveillance protocol, based on the detection of functional changes and their correction by a new PTA method for VA performed under color Doppler ultrasonography (CDU) guidance. We divided the patients into two groups: group A, before May 1999 (retrospective study) without the surveillance protocol, and group B, from 1 May 1999 to January 2001 (prospective study) with the surveillance protocol. Access blood flow (Qa) was assessed every 4 weeks by ultrasound velocity dilution. In cases of a reduction of >or=35% from the baseline value, VA was examined using CDU: if a stenosis >50% was detected, angioplasty was performed. In cases of Qa reduction <35% we continued monitoring. By Coxs multivariate analyses, only the use of PTA with or without stenting reduced the relative risk of thrombosis by 64% during the follow-up (p=0.017 confidence intervals 88%-15%) in group B patients. Secondary patency was 80% for VA in which we performed PTA with or without stenting at 18 months, and 58% at 18 months in which we did not perform PTA. Our data show how PTA under CDU is useful to maintain and to improve graft patency. This PTA under CDU guidance allows patients to avoid surgical intervention, hospitalization, and adverse reactions to contrast media and exposure to ionizing radiation, with reduced cost and with better graft survival.
经皮腔内血管成形术（PTA）是治疗狭窄的一种可能方法。本研究旨在验证一种血管通路（VA）监测方案的影响，该方案基于功能变化的检测，并通过在彩色多普勒超声（CDU）引导下进行的一种新的VA的PTA方法对其进行纠正。我们将患者分为两组：A组为1999年5月之前（回顾性研究），未采用监测方案；B组为1999年5月1日至2001年1月（前瞻性研究），采用监测方案。每4周通过超声速度稀释法评估通路血流量（Qa）。若Qa较基线值降低≥35%，则使用CDU检查VA：若检测到狭窄>50%，则进行血管成形术。若Qa降低<35%，则继续监测。通过Cox多变量分析，在B组患者的随访期间，仅使用带或不带支架的PTA可使血栓形成的相对风险降低64%（p = 0.017，置信区间8% - 15%）。在18个月时，接受带或不带支架PTA的VA的二次通畅率为80%，未进行PTA的VA在18个月时的二次通畅率为58%。我们的数据表明，CDU引导下的PTA有助于维持和提高移植物通畅率。这种CDU引导下的PTA可使患者避免手术干预、住院以及对造影剂的不良反应和电离辐射暴露，同时降低成本并提高移植物存活率。
