Department of Interventional Radiology, Patras University Hospital, School of Medicine, Rion, Greece.
J Nephrol. 2013 Mar-Apr;26(2):389-95. doi: 10.5301/jn.5000161. Epub 2012 May 17.
A well-established method to preserve failing synthetic arteriovenous grafts (AVGs) dialysis accesses is percutaneous transluminal angioplasty (PTA). Nevertheless, the one-year primary patency rate following PTA is approximately 25%. This study was designed to compare the angiographic and clinical outcomes following stent-graft insertion versus angioplasty and/or bare metal stenting (BMS) of recurrently failing AVGs, because of anastomotic and/or venous outflow stenoses.
Self-expanding stent-grafts were deployed for the treatment of failing AVGs in case of recurrent stenosis after treatment with conventional angioplasty or bail-out BMS. Regular angiographic follow-up was scheduled every two months the first six months and every three months thereafter. Data from previous procedures on the same treatment site were retrieved from our database. Primary patency was defined as a functioning graft with a patent treatment site without angiographic restenosis >50% and without any subsequent repeat procedures. Outcome data were analyzed by Kaplan-Meier analysis.
In total, 35 patients previously treated with angioplasty and/or BMS for the treatment of recurrent significant AVG stenosis (group PTA), underwent stent-graft placement of the same treatment site (group SG). Of those, 20 patients had undergone angioplasty and 15 bail-out BMS. Mean lesion length was 4.8±1.7cm. Primary patency was significantly improved in the SG group (Hazard Ratio [HR] = 0.2 [95% CI= 0.11-0.36], P=.0001) by log-rank test. The estimated six and 12-month patency rates were 76.9% vs. 25.7%, and 61.4% vs. 8.6% for groups SG and PTA respectively, (P<.0001).
Stent-graft placement significantly improves primary patency of anastomotic and venous outflow stenoses in recurrently failing prosthetic arteriovenous grafts.
经皮腔内血管成形术（PTA）是保存衰竭的合成动静脉移植物（AVG）透析通路的一种成熟方法。然而，PTA 后一年的原发性通畅率约为 25%。本研究旨在比较支架置入与血管成形术和/或裸金属支架（BMS）治疗因吻合口和/或静脉流出道狭窄而反复出现衰竭的 AVG 的血管造影和临床结果，因为吻合口和/或静脉流出道狭窄而反复出现衰竭的 AVG。
对于因常规血管成形术或紧急 BMS 治疗后再次出现狭窄而导致衰竭的 AVG，采用自膨式支架治疗。前六个月每两个月进行一次常规血管造影随访，此后每三个月进行一次。从我们的数据库中检索到同一治疗部位之前手术的数据。原发性通畅定义为功能正常的移植物，治疗部位通畅，无血管造影再狭窄>50%，无任何后续重复手术。通过 Kaplan-Meier 分析对结果数据进行分析。
共有 35 名患者因反复出现明显的 AVG 狭窄而接受 PTA（PTA 组）和/或 BMS（BMS 组）治疗，在同一治疗部位行支架置入术（SG 组）。其中，20 例患者行血管成形术，15 例患者行紧急 BMS。平均病变长度为 4.8±1.7cm。SG 组的原发性通畅率显著提高（危险比[HR]=0.2[95%可信区间=0.11-0.36]，P=.0001）。SG 组和 PTA 组的估计 6 个月和 12 个月通畅率分别为 76.9%和 25.7%，61.4%和 8.6%（P<.0001）。
支架置入术可显著提高反复出现衰竭的人造动静脉移植物吻合口和静脉流出道狭窄的原发性通畅率。
