Kanterman R Y, Vesely T M
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
J Vasc Interv Radiol. 1995 Mar-Apr;6(2):267-71. doi: 10.1016/s1051-0443(95)71112-5.
To describe the diagnosis and morphology of abnormal fistulas between dialysis grafts and adjacent native veins in five patients and to discuss their clinical significance.
Five patients with PTFE loop-type forearm dialysis grafts were found to have graft-to-vein fistulas in the presence of venous outflow stenosis or occlusion. Three patients underwent surgical revision and two patients underwent percutaneous angioplasty of the venous obstruction. Only one patient required ligation of the abnormal graft-to-vein fistula. The clinical history, dialysis records, surgical reports, and subsequent radiographs of the fistula were reviewed to determine the clinical significance of these fistulas.
Two patients presented with partial graft thrombosis; the proximal portion of the graft remained patent due to persistent flow through the fistulous communication to an adjacent native vein. Two other patients had a graft-to-vein fistula arising from a pseudoaneurysm, which itself was originating from the graft. After either surgical or percutaneous treatment of the venous obstruction, all five grafts remained functional during the follow-up period.
These iatrogenic, small-caliber fistulas are not uncommon but only manifest during periods of elevated graft pressure. Once the graft pressure is normalized, these fistulas have minimal hemodynamic effect and need not be specifically treated.
描述5例透析移植物与相邻自体静脉之间异常瘘管的诊断及形态，并探讨其临床意义。
5例采用聚四氟乙烯（PTFE）环型前臂透析移植物的患者，在存在静脉流出道狭窄或闭塞的情况下发现有移植物-静脉瘘。3例患者接受了手术修复，2例患者接受了静脉阻塞的经皮血管成形术。仅1例患者需要结扎异常的移植物-静脉瘘。回顾了这些瘘管的临床病史、透析记录、手术报告及后续影像学资料，以确定这些瘘管的临床意义。
2例患者出现移植物部分血栓形成；由于通过瘘管与相邻自体静脉的持续血流，移植物近端仍保持通畅。另外2例患者的移植物-静脉瘘源自假性动脉瘤，而假性动脉瘤本身源自移植物。在对静脉阻塞进行手术或经皮治疗后，所有5例移植物在随访期间均保持功能。
这些医源性小口径瘘并不少见，但仅在移植物压力升高时出现。一旦移植物压力恢复正常，这些瘘管对血流动力学影响极小，无需特殊治疗。
