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紫杉醇释放高压球囊联合切割球囊血管成形术治疗失败的血液透析动静脉分流处流出道狭窄的有效性

Usefulness of paclitaxel-releasing high-pressure balloon associated with cutting balloon angioplasty for treatment of outflow stenoses of failing hemodialysis arteriovenous shunts.

作者信息

Ierardi Anna Maria, Franchin Marco, Fontana Federico, Piffaretti Gabriele, Duka Ejona, Tonolini Massimo, Miele Vittorio, Tozzi Matteo, Carrafiello Gianpaolo

机构信息

Interventional Radiology, Department of Radiology, University of Insubria, Viale L. Borri, 57, 21100, Varese (VA), Italy.

Vascular Surgery Department, University of Insubria, Viale L. Borri, 57, 21100, Varese (VA), Italy.

出版信息

Radiol Med. 2017 Jan;122(1):69-76. doi: 10.1007/s11547-016-0680-z. Epub 2016 Sep 6.

Abstract

AIM

To evaluate the technical and clinical success, primary patency (PP) and complications of angioplasty performed with paclitaxel-coated balloon (PCBs) associated with cutting balloon and for the treatment of the outflow stenoses of failing hemodialysis arteriovenous shunt.

MATERIAL AND METHODS

From September 2014 to September 2015, 50 patients with 66 stenoses were registered. Vascular accesses were autogenous (n = 20) and prosthetic (n = 30). Stenosis were documented during follow-up with routine echo-color Doppler, clinical evaluation and in the remaining incidentally during fistulography. Angioplasty was performed with cutting balloon and afterward with PCB. The mean follow-up time was 8 months (range 6-15 months). Technical success, clinical success, primary patency and complications were registered.

RESULTS

Technical success was 100 %. Clinical success was 94.7 %. Primary patency rate was 87.7 %; in five patients, a significant re-stenosis (≥50 %) was registered. A residual asymptomatic stenosis (<30 %) was registered in four cases (7 %). No major complications were registered.

CONCLUSIONS

A short-term patency benefit may be obtained including PCB in angioplasty treatment of failing hemodialysis arteriovenous shunts.

摘要

目的

评估使用与切割球囊联合的紫杉醇涂层球囊(PCB)进行血管成形术治疗失功血液透析动静脉内瘘流出道狭窄的技术成功率、临床成功率、初始通畅率(PP)及并发症情况。

材料与方法

2014年9月至2015年9月,登记了50例患者的66处狭窄。血管通路为自体血管(n = 20)和人工血管(n = 30)。随访期间通过常规超声彩色多普勒、临床评估记录狭窄情况,其余在瘘管造影时偶然发现。血管成形术先使用切割球囊,然后使用PCB进行。平均随访时间为8个月(范围6 - 15个月)。记录技术成功率、临床成功率、初始通畅率及并发症情况。

结果

技术成功率为100%。临床成功率为94.7%。初始通畅率为87.7%;5例患者出现显著再狭窄(≥50%)。4例(7%)患者存在残余无症状狭窄(<30%)。未记录到严重并发症。

结论

在失功血液透析动静脉内瘘的血管成形术治疗中,使用PCB可能获得短期通畅益处。

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