Cluzel Pascal, Chabrot Pascal, Citron Bernard, Gazuy Nicole, Cassagnes Lucie, Boyer Louis, Lipiecki Janusz, Bonniol Claude
Service d'hémodialyse, Aura Auvergne, CHU de Clermont-Ferrand, Chamalières, France.
Nephrol Ther. 2009 Dec;5(7):648-51. doi: 10.1016/j.nephro.2009.06.002. Epub 2009 Jul 18.
The dramatic occurrence, during haemodialysis sessions, of hemodynamic and cerebral symptoms in a 53-year-old haemodialysed woman with a history of aortocoronary bypass leads to discovery and treatment by percutaneous angioplasty and stenting of a significant stenosis of proximal subclavian artery, ipsilateral to the arteriovenous fistula, with retrograde flow in internal mammary artery graft and vertebral artery. All symptoms resume after interventional radiology. Analysis of literature confirms possibility of coronary artery steal induced by use of the arteriovenous fistula in haemodialysed patients with ipsilateral internal mammary bypass, especially if there is concomitant subclavian artery stenosis, and leading us to discuss the diagnostic and therapeutic implications.
一名53岁接受血液透析的女性，有主动脉冠状动脉搭桥病史，在血液透析期间出现血流动力学和脑部症状，经皮血管成形术和支架置入术发现并治疗了与动静脉瘘同侧的锁骨下动脉近端严重狭窄，伴胸廓内动脉移植物和椎动脉逆行血流。介入放射学操作后所有症状复发。文献分析证实，在有同侧胸廓内动脉搭桥的血液透析患者中，使用动静脉瘘可能诱发冠状动脉窃血，尤其是在合并锁骨下动脉狭窄时，这促使我们讨论其诊断和治疗意义。
