Fogarty导管联合内膜剥脱和内瘘限流术建立老年人复杂内瘘的诊治体会

Experiences of diagnosis and treatment for complex fistula in dialysis elderly by Fogarty catheter and line stripping

摘要:

自体动静脉内瘘是维持性血液透析患者常用的血管通路。本文采用多元化手段处理复杂内瘘，为复杂血管通路的诊断和处理提供新思路。选择病例为80岁老年男性，选择左侧肘部行内瘘手术。第1次手术顺利，术后1 h内瘘杂音和振颤突然减弱，急诊B超提示瘘口近端动脉血栓形成。二次手术先用Fogarty导管取栓，将肱动脉瘘口周围血管粥样硬化的内膜仔细剥脱，再次吻合发现远端肱动脉搏动明显减弱，再予缩窄贵要静脉，形如“戴戒”。缩窄后瘘口仍可扪及振颤，肱动脉远端搏动明显加强。术后监测内瘘血流量良好。6周后内瘘穿刺，使用至今功能良好，无并发症。希望通过学习本病例，提高国内各科医师对复杂内瘘的认识水平，以利于本病的诊治。

Abstract:

Autogenous arteriovenous fistula is a common vascular access in maintenance of hemodialysis. This paper aimed at introducing our diversified approaches in dealing with complex internal fistula, and providing new thoughts on its diagnosis and treatment. An 80- year- old male underwent fistula surgery in his left elbow. But in 1 h later, we found the noise and vibration suddenly weaken in his arteriovenous fistula. Emergency ultrasonography suggested arterial thrombosis proximal to the fistula orifice. In the second surgery, we used Forgarty catheter firstly for thrombectomy, and then stripped the atherosclerosis intima around the brachial artery fistula orifice. But we found his distal humerus pulses were decreased significantly after anastomosis, so we had to narrow the basilic vein with a piece of cardiac patch, like “wearing a ring”. After the operations, vibration was observed in the fistula orifice, and the brachial artery distal pulses were significantly strengthened. Postoperative monitoring showed that internal fistula blood flow was good. Arteriovenous fistula puncture in 6 weeks later indicated good hemodialysis efficiency, and the fistula functioned well till now, with no complications. Through this case, we hope to improve the awareness of complex fistula for the domestic physicians in order to facilitate the diagnosis and treatment of this disease.