Naoum Joseph J, Irwin Chance, Hunter Glenn C
Department of Surgery, The University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA.
Vasc Endovascular Surg. 2006 Aug-Sep;40(4):275-9. doi: 10.1177/1538574406291803.
The increasing number of patients requiring hemodialysis and the limited number of access sites have resulted in an increase in multiple graft revisions to maintain access for hemodialysis. Venous outflow or anastomotic stenoses in vascular grafts tend to recur and contribute to the difficulty in maintaining a functioning graft. Thus, extending the life of a failed graft becomes an important objective of this study, which was to assess the use of covered nitinol stents to salvage expanded polytetrafluoroethylene (ePTFE) grafts with venous anastomotic or outflow stenosis that have failed after multiple revisions. This is a review of 8 failed non-autogenous ePTFE grafts with isolated venous anastomotic or proximal outflow stenoses that had undergone multiple previous revisions, had failed percutaneous transluminal angioplasty (PTA), and required placement of a covered nitinol stent. Graft locations were forearm (2), upper arm (4), and femoral (2). The mean number of interventions per patient before stent placement was 5.87 thrombectomies (range 2-28) and 3.38 balloon angioplasties (range 2-19). Five patients had 0.62 interposition grafting and 3 had patch angioplasty. All 8 patients (100%) underwent successful dialysis after thrombectomy and stenting. The primary and secondary patency rates after stent placement were 50% and 75%, and 25% and 75%, at 3 and 6 months, respectively. Percutaneous thrombectomy, balloon angioplasty, and concomitant covered nitinol stent placement extend the function of hemodialysis access grafts that have previously failed multiple times.
需要进行血液透析的患者数量不断增加，而可供使用的血管通路部位数量有限，这导致为维持血液透析通路而进行的多次移植血管修复手术增多。血管移植中的静脉流出道或吻合口狭窄往往会复发，增加了维持移植血管功能的难度。因此，延长失败移植血管的使用寿命成为本研究的一个重要目标，本研究旨在评估使用带覆膜的镍钛合金支架挽救因静脉吻合口或流出道狭窄而在多次修复后失败的膨体聚四氟乙烯（ePTFE）移植血管。这是一项对8例失败的非自体ePTFE移植血管的回顾性研究，这些移植血管存在孤立的静脉吻合口或近端流出道狭窄，此前已接受多次修复，经皮腔内血管成形术（PTA）失败，需要植入带覆膜的镍钛合金支架。移植血管的位置为前臂（2例）、上臂（4例）和股部（2例）。在植入支架前，每位患者平均进行了5.87次血栓切除术（范围为2 - 28次）和3.38次球囊血管成形术（范围为2 - 19次）。5例患者进行了0.62次间置移植血管手术，3例患者进行了补片血管成形术。所有8例患者（100%）在血栓切除和植入支架后均成功进行了透析。植入支架后3个月和6个月时，主要通畅率分别为50%和75%，次要通畅率分别为25%和75%。经皮血栓切除术、球囊血管成形术以及同时植入带覆膜的镍钛合金支架可延长此前多次失败的血液透析通路移植血管的功能。
