Leskovar Boštjan, Furlan Tjaša, Poznič Simona, Potisek Maja, Adamlje Anton, Ključevšek Tomaž
Clin Nephrol. 2017;88(13):61-64. doi: 10.5414/CNP88FX15.
Ultrasound-guided percutaneous endovascular treatment of arteriovenous fistula (AVF) or graft failure is an alternative to radiologically-guided angioplastic methods. Its main advantages are that it can be used with open or percutaneous access, using no contrast media and no radiation. The aim of this study was to analyze the results of ultrasound-guided endovascular treatment of arteriovenous access failure.
Preoperative ultrasound was used to determine the degree of stenosis and the size of balloon used in angioplasty. Angioplasty was performed as open procedure or by using a 4 - 6 French percutaneous sheath. Indications for angioplasty were significant stenosis of native vein or polytetrafluoroethylene (PTFE) graft with or without AVF thrombosis. Stenosis was considered significant if it narrowed the lumen of AVF for more than 50% and changed the shape of the flow curve. Balloon inflation was controlled by ultrasound. Procedural success was assessed with repeated postprocedural ultrasound.
In the period from August 2012 until August 2016, 228 ultrasound-guided open or percutaneous transluminal angioplasties (PTA) were performed (61% men, mean age 66.6 ± 12.0 years), success rate was 93%. In 19 (8%) cases, ultrasound-guided PTA was used in conjunction with surgical reconstruction of arteriovenous fistula/graft and in 27 (12%) cases with thromboendarterectomy. Main complications were recoil, phlebitic vein rupture, and guidewire false route in thrombotic vessels. The main cause of access failure was perianastomotic stenosis (25%). 46% of patients required repeated PTA after the first one (after a mean time of 20.8 ± 22.8 weeks, mean number of repeated PTA 2.1 ± 1.7). Repeated PTA was done intentionally as stepped dilatation or because of rethrombosis/restenosis. Ultrasound-guided stent placement was done in 8% of PTA.
CONCLUSIONS: Ultrasound-guided endovascular treatment of arteriovenous fistula or graft is a feasible and safe method of reestablishing or maintaining a functional vascular access. .
超声引导下经皮血管腔内治疗动静脉内瘘（AVF）或移植物功能衰竭是放射学引导血管成形术的一种替代方法。其主要优点是可用于开放或经皮入路，无需使用造影剂和辐射。本研究的目的是分析超声引导下血管腔内治疗动静脉通路功能衰竭的结果。
术前超声用于确定狭窄程度及血管成形术中使用的球囊大小。血管成形术作为开放手术或使用4-6法国经皮鞘进行。血管成形术的指征为自体静脉或聚四氟乙烯（PTFE）移植物显著狭窄，伴或不伴有AVF血栓形成。如果狭窄使AVF管腔狭窄超过50%并改变血流曲线形状，则认为狭窄显著。球囊扩张由超声控制。术后重复超声评估手术成功率。
2012年8月至2016年8月期间，共进行了228例超声引导下开放或经皮腔内血管成形术（PTA）（男性占61%，平均年龄66.6±12.0岁），成功率为93%。19例（8%）患者超声引导下PTA与动静脉内瘘/移植物手术重建联合使用，27例（12%）患者行血栓内膜切除术。主要并发症为回缩、静脉破裂和血栓形成血管中的导丝误入假道。通路功能衰竭的主要原因是吻合口周围狭窄（25%）。46%的患者在首次PTA后需要再次进行PTA（平均时间为20.8±22.8周，再次PTA的平均次数为2.1±1.7）。再次PTA是有意进行逐步扩张或因再血栓形成/再狭窄而进行。8%的PTA患者进行了超声引导下支架置入。
超声引导下血管腔内治疗动静脉内瘘或移植物是重建或维持功能性血管通路的一种可行且安全的方法。
