经狭窄或闭塞的中心静脉置入长期透析导管的临床研究

目的探讨血管资源已耗竭的血液透析患者永久性血管通路的建立方法。方法 6例无法建立动静脉内瘘并有多次多部位中心静脉导管留置史的维持性血液透析患者,经血管彩超及CT血管造影(CT angiography,CTA)证实存在多处中心静脉狭窄或闭塞,对其狭窄或闭塞的头臂静脉行经皮腔内球囊扩张血管成形术(percutaneous transluminal angioplasty,PTA),然后经颈内静脉途径置入长期中心静脉导管。结果术后应用导管透析,1例患者第2次透析时血流量仅达180ml/min,调整导管位置后血流量达到250ml/min以上,其余患者血流量均在250ml/min以上,随访2～6个月,所有患者均未出现导管功能不良及感染。结论对于血管资源耗竭的患者,通过介入治疗开通狭窄或闭塞的中心静脉留置长期透析导管,是一个安全有效的建立永久性血管通路的方法。

Clinical study on placement of indwelling hemodialysis catheter through stenotic or occluded central vein

Objective To explore the creation of vascular access in hemodialysis patients whose venous resource was nearly exhausted.Methods We studied six maintenance hemodialysis patients,who had previously undergone multiple central venous catheterizations,and were unable to create an arteriovenous fistula or graft anymore.Color Doppler ultrasound and CT angiography(CTA) confirmed multiple sites of central venous stenosis or obstruction in these patients.Percutaneous transluminal angioplasty(PTA) was performed for the stenotic or occluded brachiocephalic vein,followed by placement of indwelling central venous catheter via an internal jugular vein after successful angioplasty.Results The catheter in one case provided a blood flow of only 180 ml/min in the second hemodialysis session,and reached 250 ml/min after being regulated the site of the catheter.The catheters in all other cases functioned well during hemodialysis(blood flow rate >250 ml/min).No catheter dysfunction or infection were discovered in any case in the following 2～6 months.Conclusion Interventional recanalization of the stenotic or occluded central veins for the placement of indwelling hemodialysis catheter is a safe and effective method for patients whose conventional access sites have been exhausted.