Abstract：
The construction and utilization of dependable vascular access are essential for hemodialysis. Despite its importance, complications with vascular access are common, significantly impacting patient morbidity and mortality. This report presents a novel approach to treating chronic total occlusion (CTO) in hemodialysis vascular access using the \"wire kissing technique\" an \"externalization and pull-through technique.\" An 82-year-old woman on hemodialysis had a thrombotic obstruction in her cephalic vein, which conventional methods failed to address. The wire kissing technique allowed the meeting of antegrade and retrograde wires within the CTO lesion, stabilizing the wire and facilitating balloon passage. The externalization and pull-through technique further enabled the balloon to cross the rigid CTO lesion, successfully completing percutaneous transluminal angioplasty (PTA). Post-procedure ultrasonography showed significant improvements in flow volume and resistance index. These techniques, commonly used in coronary and femoral arteries, have not been previously reported for dialysis vascular access. This case highlights a novel and effective solution for overcoming technical difficulties in crossing CTO lesions, potentially improving outcomes in vascular access for hemodialysis patients.
摘要：
可靠的血管通路的构建和利用对于血液透析至关重要。尽管它很重要,血管通路并发症很常见，显着影响患者的发病率和死亡率。本报告提出了一种使用“线吻技术”和“外化和拉穿技术”治疗血液透析血管通路慢性完全闭塞（CTO）的新方法。一名82岁接受血液透析的妇女头静脉有血栓阻塞,传统方法无法解决的问题。接吻技术允许CTO病变内顺行和逆行的线相遇，稳定线和促进气球通过。外化和牵拉技术进一步使球囊能够穿过刚性CTO病变，成功完成经皮腔内血管成形术（PTA）。术后超声检查显示流量和阻力指数显着改善。这些技术,常用于冠状动脉和股动脉，以前没有关于透析血管通路的报道。该案例突出了克服CTO病变穿越技术困难的新颖有效的解决方案，可能改善血液透析患者血管通路的结局.
