Rao Christina, Fox Stephanie, Desai Sapan S
Washington University of St. Louis, St. Louis, Missouri, USA.
Department of Vascular Surgery, Northwest Community Hospital, Arlington Heights, Illinois, USA.
Case Rep Neurol. 2017 Nov 10;9(3):252-255. doi: 10.1159/000480230. eCollection 2017 Sep-Dec.
Neuromyelitis optica, also known as Devic's disease, is an autoimmune disorder that leads to the inflammation and demyelination of nerves. Devic's disease primarily affects the optic nerve and spinal cord, but can lead to a significant loss of function throughout the body if not treated with steroid therapy or plasmapheresis. We recently saw a 62-year-old patient who received plasmapheresis for Devic's disease through a PTFE arteriovenous graft in her left arm. Her graft clotted without warning, and percutaneous thrombolysis was not successful. A new vascular access was achieved with the use of an immediate-cannulation PTFE graft, and the patient received plasmapheresis immediately after her operation. However, the patient returned within 2 weeks with a thrombosed graft. Extensive myointimal fibrosis was noted within the brachial artery and axillary vein during a graft thrombectomy. Subsequent placement of a new arteriovenous fistula in her contralateral arm was eventually successful. Myointimal fibrosis may be a sequela of symptomatic antibody-positive Devic's disease, and avoidance of synthetic materials may be indicated in this patient population to avoid exacerbation of an autoimmune response.
视神经脊髓炎，也称为德维克病，是一种自身免疫性疾病，会导致神经炎症和脱髓鞘。德维克病主要影响视神经和脊髓，但如果不采用类固醇疗法或血浆置换进行治疗，可能会导致全身功能严重丧失。我们最近接诊了一名62岁的患者，她通过左臂的聚四氟乙烯动静脉移植物接受了针对德维克病的血浆置换。她的移植物毫无征兆地发生了凝血，经皮溶栓治疗未成功。使用即时插管聚四氟乙烯移植物建立了新的血管通路，患者术后立即接受了血浆置换。然而，患者在2周内因移植物血栓形成再次前来就诊。在移植物血栓切除术期间，发现肱动脉和腋静脉内有广泛的肌内膜纤维化。随后在她的对侧手臂植入新的动静脉内瘘最终获得成功。肌内膜纤维化可能是有症状的抗体阳性德维克病的后遗症，对于该患者群体，可能需要避免使用合成材料，以避免自身免疫反应加剧。
