在功能不良的血液透析动静脉内瘘血管成形术中经垂直穿刺采用顺行-逆行单鞘反转技术的可行性。
Feasibility of an antegrade-retrograde single-sheath inverse technique via vertical puncture in dysfunctional hemodialysis arteriovenous fistula angioplasty.
作者信息
Hasegawa Tetsuya, Tsuboi Masahiro, Takahashi Yuki, Endo Akira, Gotoh Yasuo
机构信息
Department of Diagnostic Radiology, Japanese Red Cross Ishinomaki Hospital, 71, Nishimichishita, Hebita, Ishinomaki-shi, Miyagi, 986-8522, Japan.
Department of Diagnostic Radiology, Osaki Citizen Hospital, 3-8-1, Honami, Furukawa, Osaki-shi, Miyagi, 989-6183, Japan.
出版信息
CVIR Endovasc. 2024 Sep 20;7(1):69. doi: 10.1186/s42155-024-00480-4.
BACKGROUND
Stenosis resulting in dysfunctional dialysis access may occur simultaneously on the anastomotic and central venous side. The purpose of this study was to retrospectively evaluate the feasibility of a single sheath inverse technique using the vertical puncture approach to perform bidirectional transvenous percutaneous transluminal angioplasty (PTA) from a single sheath for such dialysis access stenoses.
MATERIALS AND METHODS
Twenty patients (26 cases; 13 males; median age, 74 [range: 50-89] years) who underwent PTA using the sheath inverse technique for dysfunctional arteriovenous fistula stenoses between April 2019 and June 2023 were included. All procedures were performed in an outpatient setting. A 4-cm sheath (4Fr, four cases; 5Fr, 19 cases; 6Fr, three cases) was inserted by vertical puncture through a cutaneous vein in the forearm (20 cases) or upper arm (six cases). After treating one side of the lesion, the sheath was reversed to treat the lesion on the opposite side. The vessel diameter at the sheath insertion site, the success rate of sheath inversion, the number of PTA balloon catheters used, the PTA success rate, adverse events, and primary and secondary patency rates up to one year after PTA were evaluated.
RESULTS
The median diameter at the sheath indwelling site was 5.2 (range: 3.6-9.5) mm, and sheath inversion was successful in all cases, eliminating the need to place an additional sheath at another site for contralateral stricture treatment. The number of balloon catheters used was one and two in 17 (65%) and eight cases (31%), respectively, and three in one case wherein a drug-coated balloon was used. PTA was successful in all cases and major complications were not observed. However, in one case wherein a sheath had to be placed at the arterial needle puncture site, the skin was hard, leading to difficulty in inversion, and transient venous spasm occurred post-inversion. The primary patency rates at 3, 6 and 12 months after the PTA were 87.5%, 41.7%, and 20.8%, respectively. The secondary patency rates at 6 and 12 months were 100% and 75%, respectively.
CONCLUSION
The single-sheath inverse technique for arteriovenous fistulas was feasible without sheath withdrawal.
背景
导致透析通路功能障碍的狭窄可能同时出现在吻合口和中心静脉侧。本研究的目的是回顾性评估采用垂直穿刺法的单鞘反转技术从单个鞘管进行双向经静脉腔内血管成形术（PTA）治疗此类透析通路狭窄的可行性。
材料与方法
纳入2023年4月至2023年6月期间采用鞘管反转技术对功能障碍的动静脉内瘘狭窄进行PTA治疗的20例患者（26例；男性13例；中位年龄74岁[范围：50 - 89岁]）。所有操作均在门诊进行。通过在前臂（20例）或上臂（6例）经皮静脉垂直穿刺插入一根4厘米的鞘管（4Fr，4例；5Fr，19例；6Fr，3例）。在处理一侧病变后，将鞘管反转以处理对侧病变。评估鞘管插入部位的血管直径、鞘管反转成功率、使用的PTA球囊导管数量、PTA成功率、不良事件以及PTA后长达一年的一级和二级通畅率。
结果
鞘管留置部位的中位直径为5.2毫米（范围：3.6 - 9.5毫米），所有病例鞘管反转均成功，无需在另一部位额外放置鞘管来治疗对侧狭窄。使用球囊导管的数量分别为1根（17例，65%）、2根（8例，31%），1例使用药物涂层球囊时为3根。所有病例PTA均成功，未观察到严重并发症。然而，在1例必须在动脉穿刺部位放置鞘管的病例中，皮肤变硬导致反转困难，反转后出现短暂的静脉痉挛。PTA后3个月、6个月和12个月的一级通畅率分别为87.5%、41.7%和20.8%。6个月和12个月的二级通畅率分别为100%和75%。
结论
动静脉内瘘的单鞘反转技术在不拔除鞘管的情况下是可行的。
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