血液透析血管通路相关假性动脉瘤12例临床分析
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摘要
目的分析血液透析患者穿刺血管通路所致假性动脉瘤的相关因素,探讨临床如何预防并及时诊治此严重并发症。方法回顾性分析我院收治的12例血液透析血管通路相关假性动脉瘤患者的临床特点与导致假性动脉瘤可能的危险因素,进一步了解假性动脉瘤的特征及处理方法。结果血液透析患者血管通路相关假性动脉瘤可能与直接穿刺动脉、穿刺不顺利、动静脉内瘘使用不规范、透析过程中肝素的应用及患者高血压、动脉硬化、糖尿病等有关,手术是其有效的治疗方法。结论血液透析患者,尤其是合并高血压、动脉硬化、糖尿病的患者不选择直接穿刺动脉作血管通路,首选自体动静脉内瘘,医务人员应掌握其使用时机及穿刺方法,定期的血管通路监测及早期干预,可以减少并发症。假性动脉瘤应早期手术治疗。
Objective To analyze the factors related to pseudoaneurysm caused by puncture vascular pathway in hemodialysis patients, and to investigate how to prevent and treat this serious complication in clinic. Methods Retrospective analysis was appliedto analyze the clinical characteristics and the possiblerisk factors for 12 patients with pseudoaneurysm associated with hemodialysis in our hospital. And to further understand the characteristics and treatment of pseudoaneurysms.Results Vascular pathway associated pseudoaneurysms in hemodialysis patients may be relevant to the factors, such as direct puncture artery, puncture failure, non-standard usage of arteriovenous fistula, the application of heparin during dialysis, and patients with hypertension arteriosclerosis or diabetes. Surgery was an effective treatment for those diseases. Conclusion For the patients with hemodialysis, especially patients with hypertensive arteriosclerosis diabetes, the preferred treatment is autogenous arteriovenous fistula, rather than direct puncture artery for vascular access. Pseudoaneurysm should be treated early. To reduce the complications, medical doctors should master the application time and puncture methodwith regular vascular access monitoring and early intervention.
Objective To analyze the factors related to pseudoaneurysm caused by puncture vascular pathway in hemodialysis patients, and to investigate how to prevent and treat this serious complication in clinic. Methods Retrospective analysis was appliedto analyze the clinical characteristics and the possiblerisk factors for 12 patients with pseudoaneurysm associated with hemodialysis in our hospital. And to further understand the characteristics and treatment of pseudoaneurysms.Results Vascular pathway associated pseudoaneurysms in hemodialysis patients may be relevant to the factors, such as direct puncture artery, puncture failure, non-standard usage of arteriovenous fistula, the application of heparin during dialysis, and patients with hypertension arteriosclerosis or diabetes. Surgery was an effective treatment for those diseases. Conclusion For the patients with hemodialysis, especially patients with hypertensive arteriosclerosis diabetes, the preferred treatment is autogenous arteriovenous fistula, rather than direct puncture artery for vascular access. Pseudoaneurysm should be treated early. To reduce the complications, medical doctors should master the application time and puncture methodwith regular vascular access monitoring and early intervention.
引文
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[7] Wong WK, Su TW, Cheng WL, et al. Endovascular stent graft repair is an effective and safe alternative therapy for arteriovenous graft pseudoaneurysms[J].Eur J Vasc Endovasc Surg, 2016, 52(5):682-688.
[8] 龙世清,董书雄.四肢假性动脉瘤误诊9例分析[J].中国综合临床,2001,17(12):961.
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[10] Ghanavati R, Arab Ahmadi M, Behnam B.Successful nonsurgical treatment of a radial artery pseudoaneurysm following transradial coronary angiography[J].J Tehran Heart Cent, 2017, 12(2):82-84.
[11] Fellmeth BD, Roberts AC, Bookstein JJ, et al.Postangiographic femoral artery injuties:nonsurgical repair with US-guided compression[J].Radiology, 1991, 178(3):671-675.
[12] Corso R, Rampoldi A, Vercelli R, et al. Percutaneous repair of radial artery pseudoaneurysm in a hemodialysis patient using sonographically guided thrombin injection[J].Cardiovasc Intervent Radiol, 2006, 29(1):130-132.
[2] 中国医院协会血液净化中心管理分会血液净化通路学组.中国血液透析用血管通路专家共识(第1版)[J].中国血液净化, 2014, 13(8):549-558.
[3] 张丽红,詹申,王玉柱.自体动静脉内瘘真性动脉瘤诊治体会[J].中国血液净化, 2015,14(1):37-40.
[4] 王海燕.肾脏病学[M].3版.北京:人民卫生出版社, 2008:1986.
[5] Mudoni A, Cornacchiari M, Gallieni M, et al. Aneurysms and pseudoaneurysms in dialysis access [J].Clin Kidney J, 2015, 8(4):363-367.
[6] Yildirim S, Nursal TZ, Yildirim T, et al. Brachial artery pseudoaneurysm: a rare complication after haemodialysis therapy[J]. Acta Chir Belg, 2005, 105(2):190-193.
[7] Wong WK, Su TW, Cheng WL, et al. Endovascular stent graft repair is an effective and safe alternative therapy for arteriovenous graft pseudoaneurysms[J].Eur J Vasc Endovasc Surg, 2016, 52(5):682-688.
[8] 龙世清,董书雄.四肢假性动脉瘤误诊9例分析[J].中国综合临床,2001,17(12):961.
[9] 周永昌, 郭万学.超声医学[M].3版.北京:科学技术文献出版社, 1998:746-747.
[10] Ghanavati R, Arab Ahmadi M, Behnam B.Successful nonsurgical treatment of a radial artery pseudoaneurysm following transradial coronary angiography[J].J Tehran Heart Cent, 2017, 12(2):82-84.
[11] Fellmeth BD, Roberts AC, Bookstein JJ, et al.Postangiographic femoral artery injuties:nonsurgical repair with US-guided compression[J].Radiology, 1991, 178(3):671-675.
[12] Corso R, Rampoldi A, Vercelli R, et al. Percutaneous repair of radial artery pseudoaneurysm in a hemodialysis patient using sonographically guided thrombin injection[J].Cardiovasc Intervent Radiol, 2006, 29(1):130-132.