Rundback J H, Leonardo R F, Poplausky M R, Rozenblit G
Department of Radiology, New York Medical College, Valhalla 10595, USA.
AJR Am J Roentgenol. 1998 Oct;171(4):1081-4. doi: 10.2214/ajr.171.4.9763001.
To evaluate percutaneous treatment options for preserving hemodialysis access after angioplasty-related venous rupture, we retrospectively reviewed the charts for all dialysis access angioplasties performed over a 33-month period. Seven cases of venous rupture after venous angioplasty were identified (four men and three women; mean age, 63.5 years). Treatment included observation only (n = 1), a second prolonged balloon inflation at the rupture site (n = 2), stent insertion (n = 5), and manual graft occlusion (n = 1). Treatment was successful in eliminating contrast extravasation in all patients while maintaining immediate graft function in six out of seven patients. None of the patients required emergent surgical intervention. The mean primary and secondary patency rates of the salvaged grafts after intervention were 2.3 and 9.3 months, respectively. Five of seven access sites were still patent at the most recent follow-up.
Prolonged balloon inflation or placement of a stent may salvage hemodialysis access in most patients after angioplasty-related venous rupture. Primary and secondary patency have proven to be satisfactory.
为评估血管成形术相关静脉破裂后保留血液透析通路的经皮治疗方案，我们回顾性分析了33个月期间所有透析通路血管成形术的病历。确定了7例静脉血管成形术后静脉破裂的病例（4名男性和3名女性；平均年龄63.5岁）。治疗方法包括仅观察（n = 1）、在破裂部位再次长时间球囊扩张（n = 2）、置入支架（n = 5）和人工移植物闭塞（n = 1）。所有患者造影剂外渗均消除，7例患者中有6例术后即刻移植物功能得以维持，治疗成功。无一例患者需要紧急手术干预。干预后挽救的移植物的平均初级通畅率和次级通畅率分别为2.3个月和9.3个月。在最近一次随访时，7个通路部位中有5个仍保持通畅。
血管成形术相关静脉破裂后，大多数患者可通过长时间球囊扩张或置入支架挽救血液透析通路。已证实初级和次级通畅情况令人满意。
