Department of Medical Imaging, Scarborough General Hospital-General Division, Scarborough, ON, Canada.
Cardiovasc Intervent Radiol. 2011 Oct;34(5):949-57. doi: 10.1007/s00270-010-0019-4. Epub 2010 Nov 12.
To assess the safety and effectiveness of a polytetrafluoroethylene (PTFE) encapsulated nitinol stents (Bard Peripheral Vascular, Tempe, AZ) for treatment of hemodialysis-related central venous occlusions.
Study design was a single-center nonrandomized retrospective cohort of patients from May 2004 to August 2009 for a total of 64 months. There were 14 patients (mean age 60 years, range 50-83 years; 13 male, 1 female). All patients had autogenous fistulas. All 14 patients had central venous occlusions and presented with clinical symptoms of the following: extremity swelling (14%, 2 of 14), extremity and face swelling (72%, 10 of 14), and face swelling/edema (14%, 2 of 14). There was evidence of access dysfunction with decreased access flow in 36% (5 of 14) patients. There were prior interventions or previous line placement at the site of the central venous lesion in all 14 patients. Results were assessed by recurrence of clinical symptoms and function of the access circuit (National Kidney Foundation recommended criteria).
Sixteen consecutive straight stent grafts were implanted in 14 patients. Average treated lesion length was 5.0 cm (range, 0.9-7 cm). All 14 patients had complete central venous occlusion (100% stenosis). The central venous occlusions were located as follows: right subclavian and brachiocephalic vein (21%, 3 of 14), right brachiocephalic vein (36%, 5 of 14), left brachiocephalic vein (36%, 5 of 14), and bilateral brachiocephalic vein (7%, 1 of 14). A total of 16 PTFE stent grafts were placed. Ten- or 12-mm-diameter PTFE stent grafts were placed. The average stent length was 6.1 cm (range, 4-8 cm). Technical (deployment), anatomic (<30% residual stenosis), clinical (resolution of symptoms), and hemodynamic (resolution of access dysfunction) success were 100%. At 3, 6, and 9 months, primary patency of the treated area and access circuit were 100% (14 of 14).
This PTFE encapsulated stent graft demonstrates encouraging intermediate-term patency results for central vein occlusions. Further prospective studies with long-term assessment and larger patient populations will be required.
评估聚四氟乙烯（PTFE）包裹的镍钛诺支架（Bard 外周血管，坦佩，亚利桑那州）治疗血液透析相关中心静脉阻塞的安全性和有效性。
研究设计为 2004 年 5 月至 2009 年 8 月的单中心非随机回顾性队列研究，共 64 个月。共有 14 名患者（平均年龄 60 岁，范围 50-83 岁；13 名男性，1 名女性）。所有患者均为自体瘘管。所有 14 名患者均存在中心静脉阻塞，并出现以下临床症状：四肢肿胀（14%，2/14）、四肢和面部肿胀（72%，10/14）和面部肿胀/水肿（14%，2/14）。36%（5/14）的患者存在通路功能障碍，表现为通路流量减少。所有 14 名患者的中心静脉病变部位均有先前的介入或先前的导管放置。结果通过评估临床症状的复发和通路回路的功能（美国国立肾脏基金会推荐的标准）。
14 名患者连续植入 16 个直支架移植物。平均治疗病变长度为 5.0cm（范围，0.9-7cm）。所有 14 名患者均存在完全的中心静脉阻塞（100%狭窄）。中心静脉阻塞的位置如下：右锁骨下和头臂静脉（21%，3/14）、右头臂静脉（36%，5/14）、左头臂静脉（36%，5/14）和双侧头臂静脉（7%，1/14）。共放置了 16 个 PTFE 支架移植物。放置了 10 或 12mm 直径的 PTFE 支架移植物。平均支架长度为 6.1cm（范围，4-8cm）。技术（部署）、解剖学（<30%残余狭窄）、临床（症状缓解）和血液动力学（通路功能障碍缓解）成功率均为 100%。在 3、6 和 9 个月时，治疗区域和通路的原发性通畅率为 100%（14/14）。
这种 PTFE 包裹的支架移植物为中心静脉阻塞提供了令人鼓舞的中期通畅率结果。需要进一步进行具有长期评估和更大患者人群的前瞻性研究。
