Davila Santini Luis, Etkin Yana, Nadelson Adam J, Safa Toufic
Montefiore Medical Center, The University Hospital for the Albert Einstein College of Medicine, Bronx, NY, USA.
J Vasc Access. 2012 Jan-Mar;13(1):65-70. doi: 10.5301/JVA.2011.8485.
Failing hemodialysis grafts continue to pose a challenge in the care of patients with end-stage renal disease (ESRD). We review our experience using percutaneous stent-grafts for the treatment of venous outflow stenosis and occlusion in order to assess their efficacy in nonautologous graft salvage.
This is a retrospective review of patients treated with percutaneous Viabahn® stent-grafts for failing hemodialysis arteriovenous grafts (AVGs), between 6/2006 and 12/2009. All stent-grafts were deployed across the venous anastomosis to address the outflow obstruction. Patency and re-intervention rates were estimated using Kaplan-Meier analysis.
Twenty patients had stent-grafts placed. Successful stent-grafting was defined as <30% residual stenosis and the ability to dialyze through the graft post-treatment. Technical success for stent-grafting was 100%. Median follow-up was 23 months (range 3 to 37 months). Stent-graft patency at 6 months: 94.7%, 12 months: 94.7%, 18 months: 82.1%, 24 months: 82.1%, 36 months: 82.1%. Freedom from re-intervention was 69% at 24 months and 50% at 36 months. Two AVGs failed and had to be removed without further interventions, because of complete occlusion and infection. Two patients (10%) required re-intervention for arterial inflow stenosis. One patient (5%) required balloon angioplasty and stenting of stenosis distal to the stent-graft. One patient (5%) developed in-stent stenosis and was treated with placement of a new stent. Graft salvage rate was 80% at 36 months.
Stent-grafts can be successfully used to improve freedom from re-intervention rates and overall patency rates of failing AVGs.
对于终末期肾病（ESRD）患者的护理而言，功能失代偿的血液透析移植物仍然是一个挑战。我们回顾了使用经皮覆膜支架移植物治疗静脉流出道狭窄和闭塞的经验，以评估其在非自体移植物挽救中的疗效。
这是一项对2006年6月至2009年12月期间因血液透析动静脉移植物（AVG）功能失代偿而接受经皮Viabahn®覆膜支架移植物治疗的患者的回顾性研究。所有支架移植物均部署在静脉吻合口处以解决流出道梗阻问题。使用Kaplan-Meier分析估计通畅率和再次干预率。
20例患者接受了支架移植物置入。成功的支架置入定义为残余狭窄<30%且治疗后能够通过移植物进行透析。支架置入的技术成功率为100%。中位随访时间为23个月（范围3至37个月）。支架移植物在6个月时的通畅率为94.7%，12个月时为94.7%，18个月时为82.1%，24个月时为82.1%，36个月时为82.1%。24个月时无需再次干预的比例为69%，36个月时为50%。2例AVG失败，因完全闭塞和感染而不得不移除，未进行进一步干预。2例患者（10%）因动脉流入道狭窄需要再次干预。1例患者（5%）需要对支架移植物远端的狭窄进行球囊血管成形术和支架置入。1例患者（5%）出现支架内狭窄，并通过置入新支架进行治疗。36个月时移植物挽救率为80%。
支架移植物可成功用于提高功能失代偿AVG的无再次干预率和总体通畅率。
