Heerwagen Søren T, Lönn Lars, Schroeder Torben V, Hansen Marc A
Department of Interventional Radiology, Rigshospitalet, Copenhagen, Denmark.
J Vasc Access. 2010 Jan-Mar;11(1):41-5. doi: 10.1177/112972981001100109.
Cephalic arch stenosis is a known cause of hemodialysis access failure in patients with brachiocephalic fistulas (BCFs). Outcomes of endovascular treatment are affected by resistance of the stenosis to balloon dilation, a high vein rupture rate and the development of early restenosis. The purpose of this retrospective study was to report outcomes after cutting balloon angioplasty (CBA) of cephalic arch stenosis.
In our vascular access database we identified 74 dysfunctional BCFs of which 30 (41%) were caused by cephalic arch stenosis. Seventeen fistulas in 17 patients (13 males and four females; median age 62 yrs; range 52-86) were treated with CBA (June 2005 to January 2008). Twenty-five procedures were performed. In 15 procedures, a cutting balloon was used alone and in 10 procedures CBA was followed by standard or high-pressure balloon angioplasty. Restenosis rates were calculated and patency rates were estimated with the Kaplan-Meier method.
Primary patency rates (+/-SEE) at 3, 6, 12 and 15 months were 94% (+/-6%), 81% (+/-10%), 38% (+/-14%) and 22% (+/-15%), respectively. Assisted primary patency rates (+/-SEE) at the same intervals were 100% (+/-0%), 94% (+/-6%), 77% (+/-12%) and 63% (+/-13%), respectively. The mean interval between radiological interventions was 13 months (SD=8) and the mean number of interventions required per patient-year of dialysis was 0.9.
Treatment of cephalic arch stenosis with CBA did not improve patency compared to published results of conventional PTA, but our results indicate that CBA may lower the frequency of required re-interventions.
头臂干弓狭窄是肱头静脉内瘘（BCF）患者血液透析通路失败的已知原因。血管内治疗的结果受狭窄对球囊扩张的阻力、静脉破裂率高以及早期再狭窄的发展影响。这项回顾性研究的目的是报告头臂干弓狭窄的切割球囊血管成形术（CBA）后的结果。
在我们的血管通路数据库中，我们确定了74例功能失调的BCF，其中30例（41%）是由头臂干弓狭窄引起的。对17例患者（13例男性和4例女性；中位年龄62岁；范围52 - 86岁）的17个内瘘进行了CBA治疗（2005年6月至2008年1月）。共进行了25次手术。15次手术单独使用切割球囊，10次手术在CBA后进行标准或高压球囊血管成形术。计算再狭窄率并用Kaplan-Meier方法估计通畅率。
3、6、12和15个月时的初始通畅率（±标准误）分别为94%（±6%）、81%（±10%）、38%（±14%）和22%（±15%）。相同时间间隔的辅助初始通畅率（±标准误）分别为100%（±0%）、94%（±6%）、77%（±12%）和63%（±13%）。放射学干预之间的平均间隔为13个月（标准差 = 8），每位患者每年透析所需的平均干预次数为0.9。
与传统经皮腔内血管成形术（PTA）已发表的结果相比，CBA治疗头臂干弓狭窄并未改善通畅率，但我们的结果表明CBA可能会降低所需再次干预的频率。
