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血液透析动静脉移植物和动静脉瘘狭窄及血栓形成性并发症的治疗概述

Authors
Michael Allon, MD
Ivan D Maya, MD, FACP
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS
Translators
袁发焕, 主任医师，教授

引言

血液透析需要能提供快速体外循环血流的血管通路。目前一期动静脉瘘和人造血管移植最能满足这些要求。 (参见“长期血液透析通路用动静脉瘘及人工血管内瘘”)

本专题将讨论血液透析动静脉移植物发生静脉狭窄和血栓形成并发症时的治疗方法。通过临床监测动静脉移植物来预防血栓形成的问题将单独详细介绍。 (参见“防止血液透析动静脉移植物血栓形成的检查与监测”)

狭窄的治疗

血管通路的基础狭窄是移植物或动静脉瘘血栓形成的重要预测因素。因此有人提倡以狭窄血管的成形术作为预防移植物或动静脉瘘血栓形成和/或血管通路失效的首选方法。

一般来说，针对移植物狭窄病变的抢先血管成形术不能一劳永逸地解决问题，因为其一期和二期通畅时间都很短(分别定义为到下次放射介入或手术干预的时间，以及到血管通路完全失效的时间)。即使技术上非常成功(在血管成形术时行肉眼观察，成功率接近100%)，术后3个月、6个月和12个月时的低通畅率仍令人沮丧[1-7]。

自体瘘的疗法有两种。一种是采用血管成形术挽救未成熟的动静脉瘘，另一种采用血管成形术纠正成熟动静脉瘘的狭窄病变。

                

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Literature review current through: 2017-06 . | This topic last updated: 2016-11-11.
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