Kazandjian Caroline, Petit Vincent, Favier Claire, Terriat Béatrice, Steinmetz Eric
Service de Chirurgie Cardiovasculaire et Thoracique, CHU François Mitterand, Dijon, France.
Service d'Angiologie, CHU François Mitterand, Dijon, France.
Ann Vasc Surg. 2019 Jul;58:32-37. doi: 10.1016/j.avsg.2018.10.011. Epub 2018 Nov 26.
Ultrasound-guided percutaneous angioplasty of arteriovenous fistulas (AVFs) makes it possible to avoid contrast agents and X-rays, to optimize the puncture site and to locate some stenoses on the fistulography, but is it really useful? Our objective is to report the results of our experience.
Between November 2012 and November 2017, all the patients treated according to this method in our center were collected retrospectively. The surgical indications were an insufficient maturation of the AVF, an increase in the venous pressure, an inadequate outflow, difficulties in puncture, a prolonged bleeding time, a flow drop, or an aneurysmal evolution.
During this period, 50 patients had 72 ultrasound-guided angioplasties, 64 on native AVFs (88.9%) and 8 on prosthetic AVFs (11.1%). The technical success rate was 100%. The average preoperative flow of AVFs was 506.8 ± 302.2 vs. 955.9 ± 371.4 mL/min after angioplasty. The mean duration of follow-up was 13.4 ± 12.9 months. The cumulative rates of primary, assisted primary, and secondary patency were 43.5%, 68.8%, 81.5% at 1 year and 31.7%, 63.9%, 76.8% at 2 years, respectively.
AVF angioplasty under ultrasound guidance only is feasible, effective, and represents an interesting alternative. A controlled study comparing ultrasound guidance with angioplasties performed under conventional angiographic guidance as the reference technique would better clarify the value of this technique.
超声引导下经皮动静脉内瘘血管成形术能够避免使用造影剂和X射线，优化穿刺部位，并在血管造影中定位一些狭窄，但它真的有用吗？我们的目的是报告我们的经验结果。
回顾性收集2012年11月至2017年11月在我们中心按照该方法治疗的所有患者。手术指征为动静脉内瘘成熟不足、静脉压升高、流出道不足、穿刺困难、出血时间延长、血流量下降或动脉瘤形成。
在此期间，50例患者接受了72次超声引导下血管成形术，其中64次针对自体动静脉内瘘（88.9%），8次针对人工动静脉内瘘（11.1%）。技术成功率为100%。血管成形术前动静脉内瘘的平均血流量为506.8±302.2 mL/min，术后为955.9±371.4 mL/min。平均随访时间为13.4±12.9个月。1年时的一期通畅率、辅助一期通畅率和二期通畅率分别为43.5%、68.8%、81.5%，2年时分别为31.7%、63.9%、76.8%。
单纯超声引导下的动静脉内瘘血管成形术可行、有效，是一种有吸引力的替代方法。一项将超声引导与以传统血管造影引导作为参考技术进行的血管成形术相比较的对照研究将能更好地阐明该技术的价值。
