中心静脉血管成形术对血液透析通路血流量的影响：25例有症状患者的前瞻性研究。

Effect of central venous angioplasty on hemodialysis access circuit flow: prospective study of 25 symptomatic patients.

作者信息

Yan Yan, Sudheendra Deepak, Dagli Mandeep S, William Stavropoulos S, Clark Timothy W I, Soulen Michael C, Mondschein Jeffrey I, Shlansky-Goldberg Richard D, Trerotola Scott O

机构信息

Department of Radiology, Division of Interventional Radiology, University of Pennsylvania Medical Center, 1 Silverstein, 3400 Spruce St., Philadelphia, PA 19104.

出版信息

J Vasc Interv Radiol. 2015 Jul;26(7):984-91. doi: 10.1016/j.jvir.2015.03.005. Epub 2015 Apr 15.

DOI:10.1016/j.jvir.2015.03.005

PMID:25890685

Abstract

PURPOSE

To quantify the effect of central venous percutaneous transluminal angioplasty (PTA) on blood flow within hemodialysis access circuits in patients with symptomatic central venous stenosis (CVS).

MATERIALS AND METHODS

This prospective study enrolled 30 adults with symptoms attributable to CVS ipsilateral to their access. Five subjects were deregistered because of a lack of CVS (n = 1), untreatable lesion (n = 1), or improper flow measurement timing (n = 3); 25 completed the study (15 men and 10 women; mean age, 62 y; age range, 33-87 y). There were 7 fistulae, 15 grafts, and 3 hybrid access circuits. Mean access age was 675 days (range, 16-3,039 d). Mean CVS symptom duration was 37 days (range, 3-120 d). Peripheral stenoses, if present, were treated first. Intraaccess flow was measured immediately before and immediately after CVS treatment (PTA, stent).

RESULTS

Eleven patients had only CVS, whereas 14 had at least 1 peripheral lesion in addition to CVS. All stenoses underwent PTA. Mean flow rates were 1,424 mL/min (range, 565-2,765 mL/min) before PTA and 1,535 mL/min (range, 598-2,545 mL/min) afterward, yielding a mean increase of 111 mL/min ± 456 or 15% ± 34 (range, -70% to +100%; 95% confidence interval, 1%-29%). Flow was decreased in 9 patients (36%). CVS symptoms were reduced in 24 patients (96%) and recurred in 14 (58%) within a mean of 110 days (range, 7-459 d) after initial PTA. Mean follow-up was 371 days (range, 17-592 d).

CONCLUSIONS

CVS symptoms were observed to occur over a wide range of blood flow rates. On average, central venous PTA only mildly increased flow yet reduced symptoms regardless of flow change.

摘要

目的

量化中心静脉经皮腔内血管成形术（PTA）对有症状的中心静脉狭窄（CVS）患者血液透析通路内血流的影响。

材料与方法

这项前瞻性研究纳入了30名因通路同侧CVS而出现症状的成年人。5名受试者因缺乏CVS（n = 1）、病变无法治疗（n = 1）或血流测量时间不当（n = 3）而退出研究；25名完成了研究（15名男性和10名女性；平均年龄62岁；年龄范围33 - 87岁）。有7个动静脉内瘘、15个移植物和3个混合通路。通路的平均使用时间为675天（范围16 - 3039天）。CVS症状的平均持续时间为37天（范围3 - 120天）。如有外周狭窄，先进行治疗。在CVS治疗（PTA、支架）前后立即测量通路内血流。

结果

11名患者仅有CVS，而14名患者除CVS外至少有1个外周病变。所有狭窄均接受了PTA治疗。PTA前平均流速为1424 mL/分钟（范围565 - 2765 mL/分钟），之后为1535 mL/分钟（范围598 - 2545 mL/分钟），平均增加111 mL/分钟±456或15%±34（范围 - 70%至 + 100%；95%置信区间1% - 29%）。9名患者（36%）血流下降。24名患者（96%）的CVS症状减轻，其中14名（58%）在初次PTA后平均110天（范围7 - 459天）内复发。平均随访时间为371天（范围17 - 592天）。