Vorwerk D, Günther R W, Schürmann K, Sohn M
Klinik für Radiologische Diagnostik, RWTH Aachen.
Rofo. 1995 Mar;162(3):236-40. doi: 10.1055/s-2007-1015872.
Acute thrombotic occlusion of Brescia-Cimino forearm fistulae is a severe complication. Aspects of percutaneous therapy include balloon dilatation, thrombolysis and mechanical thrombectomy. We report on 21 cases with obstructed shunts. Clinical evaluation and palpation helped to select each shunt for an individual therapeutic approach.
One patient presented with a proximal arterial occlusion, three patients with a small occluding thrombus, 4 patients with a severe stenosis but only a small amount of thrombus and 13 patients with an extended amount of clot material.
7 patients underwent balloon dilatation alone, three patients thrombolysis with rtPA and 11 patients hydrodynamic thrombectomy. Arterialized shunt flow was reestablished in 20 of 21 cases. The shunt was reused for dialysis in 17 cases. Reobstruction within two weeks after intervention occurred in two cases.
With regard to the individual clot size, different percutaneous methods are available for successful shunt recanalisation.
布雷西亚 - 奇米诺前臂动静脉内瘘急性血栓形成闭塞是一种严重的并发症。经皮治疗方法包括球囊扩张、溶栓和机械性血栓清除术。我们报告了21例内瘘阻塞的病例。临床评估和触诊有助于为每个内瘘选择个体化的治疗方法。
1例患者出现近端动脉闭塞，3例患者有小的闭塞性血栓，4例患者有严重狭窄但仅有少量血栓，13例患者有大量的血凝块物质。
7例患者仅接受球囊扩张，3例患者使用rtPA溶栓，11例患者接受水力血栓清除术。21例中有20例重建了动脉化内瘘血流。17例内瘘重新用于透析。干预后两周内有2例再次闭塞。
根据血凝块大小的不同，可采用不同的经皮方法成功实现内瘘再通。
