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浙江大学学报(医学版)  2021, Vol. 50 Issue (6): 770-776    DOI: 10.3724/zdxbyxb-2021-0121
原著     
超声引导下镍钛合金支架植入治疗动静脉瘘早期复发性狭窄
陆明晰,奚炜炜,陈昊路,郑烜,杨慧颖,李华()
浙江大学医学院附属邵逸夫医院肾内科,浙江 杭州 310016
Ultrasound-guided nitinol stent implantation in treatment of early recurrent stenosis of arteriovenous fistula
LU Mingxi,XI Weiwei,CHEN Haolu,ZHENG Xuan,YANG Huiying,LI Hua()
Department of Nephrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
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摘要:

目的:探索超声引导下镍钛合金支架植入治疗动静脉瘘(AVF)早期复发性狭窄的可行性、具体方法和效果。方法:收集2018年4月至2020年7月浙江大学医学院附属邵逸夫医院肾内科接受超声引导下镍钛合金支架植入的AVF狭窄患者共30例,所有病例均为经皮腔内血管成形术(PTA)术后早期复发性狭窄。观察超声对器材和操作的显像情况,统计技术成功率、临床成功率以及并发症的发生例次,评估干预后全通路初级通畅率、靶病变初级通畅率和次级通畅率。结果:超声可清晰显示介入器材和操作过程,技术成功率和临床成功率均为100.0%。8例患者出现支架内再狭窄,接受PTA治疗。30例患者支架植入后3、6、9、12个月的全通路初级通畅率分别为91.3%、86.2%、86.2%、64.2%,靶病变初级通畅率分别为100.0%、100.0%、86.4%、69.3%,次级通畅率为100.0%、100.0%、100.0%、94.4%。与患者支架植入前一次PTA比较,支架植入具有更高的干预后靶病变初级通畅率和更低的成本/效果比(均P<0.05)。随访期间未观察到血管破裂、假性血管瘤、支架感染、支架移位、支架外露等其他并发症。结论:超声可以清晰、精准地引导镍钛合金支架植入患者AVF中,对患者PTA术后早期复发性狭窄的近、中期疗效较好。

关键词: 介入超声动静脉瘘缩窄, 病理性支架经皮腔内血管成形术    
Abstract:

Objective: To investigate the feasibility, methods and efficacy of ultrasound-guided nitinol stent implantation for the treatment of early recurrent stenosis of arteriovenous fistula (AVF). Methods: Thirty patients with early recurrent stenosis after percutaneous transluminal angioplasty (PTA) who received ultrasound-guided nitinol stent implantation in Sir Run Run Shaw Hospital of Zhejiang University from April 2018 to July 2020 were followed up. The imaging features of the procedure and the interventional devices were observed under ultrasonography. The technical success rate and the clinical success rate as well as the incidence of complication were assessed. The post-interventional primary patency rates of access circuit, primary patency rates of target lesion and secondary patency rates were estimated. Results: Ultrasonography was able to demonstrate the operation process and the interventional devices clearly. The technical and clinical success rates were both 100.0%. Eight patients had in-stent restenosis, which were treated by PTA. The post-interventional primary patency rates of the access circuit after 3, 6, 9 and 12?months were 91.3%, 86.2%, 86.2% and 64.2%, respectively; the post-interventional primary patency rates of target lesion were 100.0%, 100.0%, 86.4% and 69.3%, respectively; the post-interventional secondary patency rates were 100.0%, 100.0%, 100.0% and 94.4%, respectively. Compared with previous PTA in these cases, stent implantation had a higher post-interventional primary patency rates of target lesion and a lower cost-effectiveness (both P<0.05). No other complications such as vascular rupture, pseudohemangioma, stent infection, stent displacement and stent exposure were observed during the follow-up.Conclusion: Ultrasonography can accurately guide the nitinol stent implantation in AVF, and the technique is feasible in treatment for the early recurrent stenosis after PTA with good short- and medium-term efficacy.

Key words: Interventional ultrasound    Arteriovenous fistula    Constriction, pathologic    Stents    Percutaneous transluminal angioplasty
收稿日期: 2021-04-27 出版日期: 2022-03-22
CLC:  R459.9  
基金资助: 浙江省基础公益研究计划(LGF21H050004)
通讯作者: 李华     E-mail: lihua@srrsh.com
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引用本文:

陆明晰,奚炜炜,陈昊路,郑烜,杨慧颖,李华. 超声引导下镍钛合金支架植入治疗动静脉瘘早期复发性狭窄[J]. 浙江大学学报(医学版), 2021, 50(6): 770-776.

LU Mingxi,XI Weiwei,CHEN Haolu,ZHENG Xuan,YANG Huiying,LI Hua. Ultrasound-guided nitinol stent implantation in treatment of early recurrent stenosis of arteriovenous fistula. J Zhejiang Univ (Med Sci), 2021, 50(6): 770-776.

链接本文:

https://www.zjujournals.com/med/CN/10.3724/zdxbyxb-2021-0121        https://www.zjujournals.com/med/CN/Y2021/V50/I6/770

图 1  超声引导下镍钛合金支架植入主要步骤的超声影像A:支架植入前对狭窄的预扩张;B:支架释放前的定位,支架呈“鱼骨头”样回声,箭头所指为支架前端;C:支架前端锚定血管壁;D:支架释放完毕;E:对植入支架及狭窄的后扩张;F:扩张成形的支架.
图 2  一例患者支架内再狭窄的超声图像支架内管腔彩色血流流束变细,箭头所指的低回声组织为增生的内膜.
图 3  超声引导下镍钛合金支架植入后全通路初级通畅率、靶病变初级通畅率和次级通畅率
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