Rajan Dheeraj K, Saluja Jasdeep S
Division of Vascular and Interventional Radiology, Department of Medical Imaging, Toronto General Hospital, University Health Network University of Toronto, M5G 2N2, Toronto, Ontario, Canada.
Cardiovasc Intervent Radiol. 2007 Jul-Aug;30(4):662-7. doi: 10.1007/s00270-007-9083-9.
To retrospectively review the patency of endovascular interventions with nitinol stent placement for symptomatic central venous occlusions in hemodialysis patients.
A retrospective review of all patients who underwent endovascular interventions for dysfunctional hemodialysis grafts and fistulas was performed from April 2004 to August 2006. A total of 6 patients presented with arm and/or neck and facial swelling and left brachiocephalic vein occlusion. The study group consisted of 3 men and 3 women with a mean age of 79.5 years (SD 11.2 years). Of these 6 patients, 1 had a graft and 5 had fistulas in the left arm. The primary indication for nitinol stent placement was technical failure of angioplasty following successful traversal of occluded central venous segments. Patency was assessed from repeat fistulograms and central venograms performed when patients redeveloped symptoms or were referred for access dysfunction determined by the ultrasound dilution technique. No patients were lost to follow-up.
Nitinol stent placement to obtain technically successful recanalization of occluded venous segments was initially successful in 5 of 6 patients (83%). In 1 patient, incorrect stent positioning resulted in partial migration to the superior vena cava requiring restenting to prevent further migration. Clinical success was observed in all patients (100%). Over the follow-up period, 2 patients underwent repeat intervention with angioplasty alone. Primary patency was 83.3% (95% CI 0.5-1.2) at 3 months, and 66.7% at 6 and 12 months (0.2-1.1, 0.1-1.2). Secondary patency was 100% at 12 months with 3 patients censored over that time period. Mean primary patency was 10.4 months with a mean follow-up of 12.4 months. No complications related to recanalization of the occluded central venous segments were observed.
Our initial experience has demonstrated that use of nitinol stents for central venous occlusion in hemodialysis patients is associated with good mid-term patency and may exceed historical observations with prior use of Wallstents.
回顾性分析在血液透析患者中，采用镍钛合金支架置入术对有症状的中心静脉闭塞进行血管腔内介入治疗后的通畅情况。
对2004年4月至2006年8月期间所有因血液透析移植物和内瘘功能障碍而接受血管腔内介入治疗的患者进行回顾性分析。共有6例患者出现手臂和/或颈部及面部肿胀，以及左头臂静脉闭塞。研究组包括3名男性和3名女性，平均年龄79.5岁（标准差11.2岁）。在这6例患者中，1例有移植物，5例在左臂有内瘘。镍钛合金支架置入的主要指征是在成功穿过闭塞的中心静脉段后血管成形术技术失败。当患者再次出现症状或因超声稀释技术确定的通路功能障碍而被转诊时，通过重复的内瘘造影和中心静脉造影评估通畅情况。没有患者失访。
在6例患者中的5例（83%），镍钛合金支架置入术最初成功实现了闭塞静脉段的技术上成功再通。1例患者，支架定位错误导致部分移位至上腔静脉，需要再次置入支架以防止进一步移位。所有患者均观察到临床成功（100%）。在随访期间，2例患者仅接受了血管成形术的重复干预。3个月时的初级通畅率为83.3%（95%可信区间0.5 - 1.2），6个月和12个月时为66.7%（0.2 - 1.1，0.1 - 1.2）。12个月时的次级通畅率为100%，在此期间有3例患者被审查。平均初级通畅时间为10.4个月，平均随访时间为12.4个月。未观察到与闭塞中心静脉段再通相关的并发症。
我们的初步经验表明，在血液透析患者中使用镍钛合金支架治疗中心静脉闭塞与良好的中期通畅率相关，可能超过既往使用Wallstents的历史观察结果。
