目的:探索超声引导下经皮紫杉醇涂层球囊腔内血管成形术(PCBA)在真实世界中治疗血液透析动静脉内瘘狭窄的可行性及有效性.方法:选取 2018 年 7 月至 2023 年 9 月在浙江大学医学院附属邵逸夫医院接受PCBA治疗并随访≥6 月的患者 81 例,统计其基线资料、技术成功率、临床成功率、并发症情况及初级通畅时间.结果:PCBA技术成功率 98.8%,临床成功率 98.8%.未出现血管破裂等严重并发症.靶病变长度 2.5(1.15,4.15)cm,扩张后靶病变内径明显改善(4.35±0.82 mm vs 1.65±0.51 mm);靶病变最大内膜厚度明显缩小(0.72±0.19 mm vs 1.73±0.51 mm);肱动脉流量明显增加[813(644,959)mL/min vs 362(267,513)mL/min].靶病变3 月、6 月、12 月、24 月初级通畅率分别为 90.1%、83.9%、52.8%、36.7%.自体瘘瘘体静脉靶病变及支架内靶病变 3 月、6 月、12 月、24 月初级通畅率分别为 89.7%、84.5%、59.5%、42.2%及 92.9%、85.7%、56.9%、38.4%.结论:PCBA可扩张内瘘狭窄部位内径,明显改善内瘘流量,对支架内狭窄的治疗疗效同样显著.
Preliminary study on the curative effect of ultrasound guided paclitaxel-coated balloon dilation in patients with hemodialysis arteriovenous fistula stenosis
Objective:To explore the feasibility and effectiveness of ultrasound guided percutaneous paclitaxel-coated balloon angioplasty(PCBA)for the treatment of hemodialysis arteriovenous fistula stenosis in the real world.Methodology:A total of 81 patients who received PCBA at Run Run Shaw Hospital,Zhejiang University School of Medicine from July 2018 to September 2023 and were followed up for at least six months were retrospectively included.Baseline data,technical success rate,clinical success rate,complications,and primary patency time were analyzed.Results:The PCBA technical success rate was 98.8%,same as the clinical success rate.No serious complications such as rupture of blood vessels was found.The length of the target lesion was 2.5(1.15,4.15)cm,and the internal diameter of the target lesion was significantly improved after PCBA(4.35±0.82 mm vs 1.65±0.51 mm).The maximum intimal thickness of the target lesion was significantly reduced(0.72±0.19 mm vs 1.73±0.51 mm).Brachial artery flow was significantly increased[813(644,959)mL/min vs 362(267,513)mL/min].The primary patency rates of target lesions at 3,6,12,and 24 months were 90.1%;83.9%;52.8%;36.7%.The primary patency rates of autologous fistula venous target lesion and stent target lesion at 3,6,12 and 24 months were 89.7%,84.5%,59.5%,42.2%and 92.9%,85.7%,56.9%,38.4%respectively.Conclusion:PCBA can significantly improve the inner diameter of the target lesions as well as brachial artery flow.It also can improve the primary patency rate of the target lesions of the fistula vein in the autologous fistula and in-stent restenosis.Ultrasound can clearly,accurately and safely guide paclitaxel drug-coated balloon to relieve arteriovenous fistula stenosis.
arteriovenous fistula stenosispaclitaxel-coated balloon angioplastyprimary patency time
NETL
NSTL
万方数据
