Yevzlin Alexander, Asif Arif
Department of Medicine, Section of Interventional Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Clin J Am Soc Nephrol. 2009 May;4(5):996-1008. doi: 10.2215/CJN.04040808. Epub 2009 Apr 30.
Vascular access stenosis in patients undergoing chronic hemodialysis is a major issue that is associated with increased morbidity, mortality, and cost of medical care. Recent data have emphasized that endovascular stents could be used in the treatment of central as well as peripheral stenotic lesions. In general, a peripheral or central vein lesion that is elastic or recurs within a three-month period after an initially successful balloon angioplasty or a stenosis where surgical revision is not possible are some indications for intravascular stent placement. Recent reports have expanded the role of stents in the management of pseudoaneurysms associated with dialysis access. In this context, the utilization of these devices must take into account a fair comparison with the traditional (surgical) approaches regarding effectiveness as well as costs. This report describes the role of stents in arteriovenous dialysis access. In addition, some of the recent advances in the structure and complicating issues such as stent fracture, migration, and infection, as well cannulation through the stent, are discussed.
接受慢性血液透析的患者出现血管通路狭窄是一个重大问题，与发病率、死亡率增加以及医疗费用上升相关。近期数据强调，血管内支架可用于治疗中心及外周狭窄病变。一般来说，外周或中心静脉病变具有弹性或在初次成功进行球囊血管成形术后三个月内复发，或者存在无法进行手术修复的狭窄，这些都是血管内支架置入的一些指征。近期报告扩大了支架在与透析通路相关的假性动脉瘤管理中的作用。在这种情况下，使用这些装置必须在有效性和成本方面与传统（手术）方法进行合理比较。本报告描述了支架在动静脉透析通路中的作用。此外，还讨论了支架结构方面的一些最新进展以及诸如支架断裂、移位和感染等复杂问题，以及通过支架进行插管的问题。
