Department of Radiology, Baskent University Faculty of Medicine, Fevzi Cakmak Cd. 10. Sk. No: 45, Bahcelievler, Ankara 06490, Turkey.
AJR Am J Roentgenol. 2009 Dec;193(6):1672-9. doi: 10.2214/AJR.09.2654.
The objective of our study was to report and compare long-term results of percutaneous transluminal angioplasty and stenting of central venous obstruction in hemodialysis patients.
Hemodialysis patients who underwent successful endovascular treatment of central venous obstruction were retrospectively evaluated. Stenotic lesions greater than 50% or inducing extremity swelling were subject to treatment. The primary treatment was angioplasty, and stent placement was accomplished in angioplasty-resistant obstructions. Angioplasty was the primary treatment of recurrence after stent placement. Additional stenting was reserved for angioplasty-resistant recurrences.
One hundred forty-seven veins in 126 patients (63 males, 63 females) between 15 and 82 years old primarily underwent 101 angioplasties and 46 stent placements. The mean follow-up was 22.1 +/- 16.3 (SD) months. The average number of interventions per vein in the stent group (2.7 +/- 2.4 interventions) was significantly higher than that in the angioplasty group (1.5 +/- 1.0 interventions). Primary patency was significantly higher in the angioplasty group (mean, 24.5 +/- 1.7 months) than that in the stent group (mean, 13.4 +/- 2.0 months). Assisted primary patency of the angioplasty group (mean, 31.4 +/- 2.0 months) and that of the stent group (mean, 31.0 +/- 4.7 months) were equivalent. The overall mean primary patency was 21.1 +/- 1.4 months, and the overall mean assisted primary patency was 31.7 +/- 2.5 months. There were no significant differences in patency rates with regard to patient sex, the type of stent used, the vein or veins treated, or the type of lesions.
Endovascular treatment of central venous obstruction is a safe and effective procedure in hemodialysis patients. Stenting has a significantly lower primary patency rate than angioplasty but adds to the longevity of vein patency in angioplasty-resistant lesions; therefore, stent placement should be considered in angioplasty-resistant lesions.
本研究旨在报告并比较经皮腔内血管成形术和支架置入治疗血液透析患者中心静脉阻塞的长期结果。
回顾性评估接受腔内血管成形术成功治疗中心静脉阻塞的血液透析患者。狭窄程度大于 50%或引起肢体肿胀的病变需要治疗。主要治疗方法是血管成形术，对于血管成形术抵抗性阻塞则进行支架置入。支架置入后复发则采用血管成形术治疗。对于血管成形术抵抗性复发，则保留额外的支架置入。
126 例患者（63 名男性，63 名女性）共 147 条静脉，年龄 15-82 岁，其中 101 条静脉行血管成形术，46 条静脉行支架置入。平均随访时间为 22.1±16.3（SD）个月。支架组（2.7±2.4 次干预）每条静脉的平均干预次数明显高于血管成形术组（1.5±1.0 次干预）。血管成形术组的初始通畅率（平均 24.5±1.7 个月）明显高于支架组（平均 13.4±2.0 个月）。血管成形术组（平均 31.4±2.0 个月）和支架组（平均 31.0±4.7 个月）的辅助初始通畅率相当。总的初始通畅率为 21.1±1.4 个月，总的辅助初始通畅率为 31.7±2.5 个月。患者性别、支架类型、治疗的静脉或静脉类型、病变类型等与通畅率均无显著差异。
经皮腔内血管成形术和支架置入治疗血液透析患者中心静脉阻塞是一种安全有效的方法。支架置入的初始通畅率明显低于血管成形术，但增加了血管成形术抵抗性病变的静脉通畅时间；因此，对于血管成形术抵抗性病变应考虑支架置入。
