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血液透析患者中心静脉成形术的治疗结果

Outcomes of Central Venoplasty in Haemodialysis Patients.

作者信息

Cuthbert Gary Andrew, Lo Zhiwen Joseph, Kwan Justin, Chandrasekar Sadhana, Tan Glenn Wei Long

机构信息

Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK.

Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore.

出版信息

Ann Vasc Dis. 2018 Sep 25;11(3):292-297. doi: 10.3400/avd.oa.18-00025.

Abstract

: To review the outcomes of central venoplasty in the treatment of symptomatic central vein stenosis in patients undergoing haemodialysis via an ipsilateral arteriovenous fistula (AVF). : Data were collected retrospectively, and included all the consecutive cases of central venoplasty between January 2008 and December 2015. : A total of 132 central venoplasties in 76 patients were performed, with incidence of symptomatic central vein stenosis at 7.4%. Of the patients, 66% were male and the mean age was 61 years. The most frequent indication was decreased dialysis access flow rates (58%) and 52% of all the patients had symptoms of upper limb swelling. The patients who had previous ipsilateral tunneled internal jugular vein dialysis catheters made up 58% of the patients. The mean time from AVF creation to first central venoplasty was 24 months, and 74% of the cases required a second central venoplasty and the mean time to second venoplasty was 7 months. The overall post intervention assisted primary patency rate was 87%, 74%, 63%, and 42% at 6, 12, 18, and 24 months respectively. Statistically significant differences were found in primary assisted patency (p=0.025) and time to second procedure (p=0.039) comparing those with and without a history of ipsilateral tunneled dialysis catheter. : Central venoplasty is technically feasible with low procedural risk. The maintenance of the AVF patency usually requires multiple procedures at average interval of 7 months. Patients with a history of upper limb tunneled dialysis catheter ipsilateral to the side of central vein stenosis or AVF have a less favorable outcome compared to those without.

摘要

回顾经同侧动静脉内瘘(AVF)进行血液透析的患者中,中心静脉成形术治疗有症状的中心静脉狭窄的疗效。回顾性收集2008年1月至2015年12月期间所有连续的中心静脉成形术病例。共对76例患者进行了132次中心静脉成形术,有症状的中心静脉狭窄发生率为7.4%。患者中66%为男性,平均年龄61岁。最常见的适应证是透析通路血流量降低(58%),52%的患者有上肢肿胀症状。既往有同侧隧道式颈内静脉透析导管的患者占58%。从建立AVF到首次中心静脉成形术的平均时间为24个月,74%的病例需要进行第二次中心静脉成形术,第二次静脉成形术的平均时间为7个月。干预后辅助原发性通畅率在6、12、18和24个月时分别为87%、74%、63%和42%。在比较有或无同侧隧道式透析导管病史的患者时,原发性辅助通畅率(p = 0.025)和至第二次手术时间(p = 0.039)存在统计学显著差异。中心静脉成形术在技术上可行,手术风险低。维持AVF通畅通常需要平均间隔7个月进行多次手术。与无此病史的患者相比;有中心静脉狭窄或AVF同侧上肢隧道式透析导管病史的患者预后较差。

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