Department of Radiology, University of California Los Angeles, 10833 LeConte Ave., Mail Code CHS 172115, Los Angeles, CA 90095, USA.
J Vasc Interv Radiol. 2011 May;22(5):647-53. doi: 10.1016/j.jvir.2010.12.013. Epub 2011 Mar 3.
To investigate the use of an expanded polytetrafluoroethylene-coated nitinol stent-graft in patients with failing hemodialysis access circuits and compare grafts with and without a heparin-coated surface.
A single-institution retrospective review of 16 patients (average age, 55 years; seven men) treated for hemodialysis access circuit stenoses was performed. Patients had a prosthetic arteriovenous (AV) graft (n = 10) or autogenous AV fistula (n = 6), all with clinically relevant access stenoses that were refractory to angioplasty alone; 10 patients also had access circuit thrombosis at the time of treatment. Stents were placed in the basilic (n = 4), brachial (n = 7), cephalic (n = 4), and femoral (n = 1) veins. Study endpoints included primary treatment area patency, primary circuit patency, primary assisted circuit patency, and secondary circuit patency, followed to a maximum of 6 months.
Primary treatment area patency rates at 30 days and 180 days were 75% and 31%, respectively. Secondary patency rates at the same time points were 88% and 68%, respectively. Mean primary treatment area patency was 93 days. Thrombosis was a major cause of failure, occurring in seven of 11 cases of primary treatment area patency loss. Subgroup analysis demonstrated that the heparin-coated configuration (n = 7) showed a 6-month primary patency rate of 57%, compared with 11% for the stent-grafts without heparin bonding (n = 9; P = .06).
Overall, the majority of deployed stent-grafts lost primary patency within 6 months, with thrombosis a major cause of failure. However, the addition of a heparin-coated surface appeared to improve results in these otherwise treatment-refractory access circuits.
研究在血液透析通路失功的患者中使用膨体聚四氟乙烯涂层镍钛诺支架移植物，并比较有无肝素涂层表面的移植物。
对 16 例（平均年龄 55 岁；7 例男性）因血液透析通路狭窄而行治疗的患者进行了单机构回顾性研究。患者均存在动静脉（AV）人造移植物（n = 10）或自体 AV 瘘（n = 6），所有患者均存在临床上相关的且对单纯血管成形术有抗性的通路狭窄；10 例患者在治疗时还存在通路血栓形成。支架分别置于贵要静脉（n = 4）、肱动脉（n = 7）、头静脉（n = 4）和股静脉（n = 1）。研究终点包括主要治疗区域通畅率、主要通路通畅率、主要辅助通路通畅率和次要通路通畅率，随访时间最长为 6 个月。
30 天和 180 天的主要治疗区域通畅率分别为 75%和 31%。同期的次要通畅率分别为 88%和 68%。平均主要治疗区域通畅时间为 93 天。血栓形成是导致失败的主要原因，11 例主要治疗区域通畅率丧失中有 7 例发生血栓形成。亚组分析表明，肝素涂层组（n = 7）的 6 个月主要通畅率为 57%，而无肝素结合支架组（n = 9）为 11%（P =.06）。
总的来说，大多数置入的支架移植物在 6 个月内失去了主要通畅性，血栓形成是失败的主要原因。然而，添加肝素涂层表面似乎改善了这些治疗抵抗性通路的结果。
