血管内介入在儿科动静脉瘘血液透析的维持和抢救中的应用。
Endovascular intervention in the maintenance and rescue of paediatric arteriovenous fistulae for hemodialysis.
机构信息
Guy's and St. Thomas' NHS Foundation Trust, London, UK.
Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
出版信息
Pediatr Nephrol. 2019 Apr;34(4):723-727. doi: 10.1007/s00467-018-4143-8. Epub 2018 Nov 27.
BACKGROUND
Arteriovenous fistulae (AVF) provide superior primary vascular access for children on chronic dialysis compared to central venous catheters (CVC). However, AVFs inevitably develop complications and will require some intervention to maintain long-term functional patency.
METHODS
We report an 'endovascular-first' approach to the maintenance and rescue of paediatric AVFs. Thirty interventions targeting 46 lesions in 18 children (median age 11 years [range 5-17]) were performed. Sixty-eight percent of the AVFs were brachio-cephalic fistulae, 26% brachio-basilic fistulae and 5% radio-cephalic fistulae. Immediate functional success was 86% with good dialysis adequacy (mean urea reduction ratio > 70%) at 3 months post procedure.
RESULTS
There was one significant complication, consisting of an AVF rupture which was managed with a covered stent.
CONCLUSIONS
Repeated interventions may be necessary to maintain AVF patency and avoid central venous catheters. This is the largest series reported to date.
背景
与中心静脉导管（CVC）相比，动静脉瘘（AVF）为慢性透析患儿提供了更优的主要血管通路。然而，AVF 不可避免地会出现并发症，需要进行一些干预来维持长期的功能通畅。
方法
我们报告了一种“血管内优先”的方法来维持和抢救儿科 AVF。对 18 名儿童（中位年龄 11 岁[范围 5-17]）的 46 个病变进行了 30 次干预。68%的 AVF 是头臂静脉瘘，26%是头臂正中静脉瘘，5%是桡尺静脉瘘。术后 3 个月，即时功能成功率为 86%，透析充分性良好（平均尿素降低率>70%）。
结果
有 1 例严重并发症，为 AVF 破裂，采用覆膜支架治疗。
结论
可能需要反复干预来维持 AVF 的通畅，避免使用 CVC。这是迄今为止报告的最大系列。
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