1 Icahn School of Medicine at Mount Sinai, New York, NY, USA.
J Endovasc Ther. 2017 Oct;24(5):743-745. doi: 10.1177/1526602817718539. Epub 2017 Jul 5.
To report an investigation of a purely endovascular procedure to address access-induced hand ischemia in dialysis patients.
Two dialysis patients presented with stage III steal syndrome consisting of severe pain and numbness in their fingers. Preoperative fistulograms distal to the anastomosis showed alternating antegrade and retrograde flow. Under ultrasound guidance, the fistula was accessed and a 4-F micropuncture sheath placed. An angled guidewire was then advanced proximally into the brachial artery. A 6-F short sheath with marker was placed followed by a 4-F straight guide catheter inserted into the proximal brachial artery. A 9-F Flair endovascular stent-graft was advanced over a 0.035-inch stiff angled Glidewire into the fistula just distal to the arterial anastomosis and deployed. Postoperatively, pain and numbness resolved in both patients immediately. Postoperative fistulograms documented antegrade flow. Access flow velocity readings decreased significantly and pulse oximetry readings increased significantly in both patients, who were followed for >6 months with no reported complications.
These 2 cases suggest that this endovascular approach to access-induced hand ischemia may be a viable alternative to open/hybrid surgery.
报告一种纯粹的血管内手术方法，用于治疗透析患者因通路引起的手部缺血。
两名透析患者出现 III 期窃血综合征，表现为手指严重疼痛和麻木。吻合口远端的术前动静脉瘘造影片显示交替的顺行和逆行血流。在超声引导下，进入瘘管并放置 4-F 微穿刺鞘。然后将角度导丝向近心端推进至肱动脉。随后放置一个带有标记的 6-F 短鞘和一个 4-F 直导引导管，插入近端肱动脉。将一个 9-F Flair 血管内支架移植物通过 0.035 英寸的硬角 Glidewire 推进到动脉吻合口远端的瘘管中并进行释放。术后，两名患者的疼痛和麻木立即缓解。术后动静脉瘘造影片显示顺行血流。两名患者的通路血流速度读数显著降低，脉搏血氧饱和度读数显著升高，随访超过 6 个月，无报告的并发症。
这 2 个病例表明，这种治疗通路引起的手部缺血的血管内方法可能是开放/杂交手术的可行替代方法。
