动静脉内瘘和起搏器同侧所致肿胀手综合征及腔内治疗效果观察

    Observation of swollen hand syndrome caused by arteriovenous fistula and pacemaker on the same side and the effect of endovascular therapy

    • 摘要: 目的 观察自体动静脉内瘘(arteriovenous fistula,AVF)和起搏器位于患者手臂同侧时是否容易出现肿胀手综合征以及腔内治疗效果。方法 试验组:起搏器同侧建立AVF的患者10例;对照组:起搏器对侧建立AVF的患者10例。观察内容:(1)内瘘侧颈静脉或锁骨下静脉有无透析导管置入史;(2)存在起搏器导线的情况下AVF术后或者存在AVF的情况下同侧安装起搏器术后出现内瘘侧肢体肿胀时间;(3)中心静脉狭窄或者闭塞部位;(4)腔内治疗方法;(5)腔内治疗后复发时间;(6)经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)对起搏器导线功能有无影响。结果 试验组:8例患者内瘘、起搏器同侧共存17.0(2.6,30.0)个月后开始出现肢体肿胀;1例患者内瘘、起搏器同侧共存3.5年后内瘘闭塞,闭塞前内瘘侧肢体仅有轻度肿胀,无需干预;1例患者内瘘、起搏器同侧共存4.5年内瘘侧肢体无肿胀。治疗上,2例患者对侧上肢重新建立内瘘,新的内瘘成熟后关闭患侧内瘘。6例患者行单纯PTA治疗,共10例次,单纯PTA术后至肿胀复发时间为(6.0±4.9)个月,所有患者均未置入支架。PTA术后起搏器功能无异常。对照组:截止到观察终点所有患者均未出现内瘘侧肢体肿胀。结论 动静脉内瘘和起搏器位于同侧时相对容易出现肿胀手综合征,中心静脉病变单纯PTA效果相对较差,不建议放置支架。短期观察球囊扩张对起搏器导线功能无明显影响。

       

      Abstract: Objective To observe whether the arteriovenous fistulas(AVF)and pacemakers on the same side are prone to cause swollen hand syndrome and to observe the effect of endovascular therapy. Methods Experimental group:10 patients with arteriovenous fistulas on the same side of pacemaker;control group:10 patients with arteriovenous fistulas on the opposite side of pacemaker.Observation:(1)Whether there is a history of dialysis catheter insertion in jugular vein or subclavian veinon the side of arteriovenous fistula;(2)How long the limb swelling on the fistula side lasts after a pacemaker is placed on the same side after AVF or with AVF under the condition of existence of a pacemaker lead;(3)Central vein stenosis or occluded site;(4)Endovascular therapy;(5)When it recurs after endovascular therapy;(6)Whether percutaneous transluminal angioplasty(PTA)affects pacemaker function. Results In the experimental group:eight patients started to develop limb swelling after co-existence of AVF and pacemaker on the same side for 17.0(2.6,30.0)months;one patient experienced fistular occlusion after co-existence of AVF and pacemaker on the same side for 3.5 years,and did not need to intervene because of mild limb swelling on the side of fistula before occlusion;one patient had no limb swelling after co-existence of AVF and pacemaker on the same side for 4.5 years.For the treatment,two patients underwent AVF once again on the opposite side,and the fistula on the affected side was closed after maturation of the new fistula. Six patients were treated with PTA alone ten times in total.The interval from PTA alone to swelling recurrence was(6.0±4.9)months,and no stent was implanted in all patients.Pacemaker function was normal after PTA.Control group:By the end point of observation,all patients had no swelling of the limbs on the side of arteriovenous fistula. Conclusions When arteriovenous fistula and pacemaker are located on the same side,swollen hand syndrome is relatively easy to occur.The effect of simple PTA for central venous lesions is relatively poor,stents are not recommended.Short term observation shows that balloon dilation has no significant effect on the function of a pacemaker lead.

       

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