Akron General Medical Center, Akron, Ohio 44307, USA.
J Vasc Surg. 2013 Jan;57(1):144-8. doi: 10.1016/j.jvs.2012.06.087. Epub 2012 Oct 9.
Endovascular stent grafts are utilized in the rescue of failing arteriovenous (AV) access. Reports claim the superiority of stent grafts and recommend these as a first-line treatment. We have observed a rise in the number of complications related to stent grafts in our patients. The following study was undertaken to assess the severity of these complications and their effect on access site maintenance.
We reviewed all patients who had endovascular stent grafts placed for treatment of failing dialysis access over the last 44 months. A series of 38 consecutively placed stent grafts was reviewed for stent migration, fracture, erosion, hemorrhage, and rupture at the site of the stent grafts. Hospital charts were reviewed to assess for indications, hemodynamic stability, transfusion requirement, and outcome.
Of 38 stent grafts placed, nine were for pseudoaneurysm (PS), 20 for stenosis (ST), and nine for a combination (PS/ST). The average length of follow-up was 218.6 days. Primary patency was 49%, with an assisted primary patency of 76%. Eleven patients (28.9%) presented with complications related to migration, fracture, erosion, or rupture. Six were in the PS, three in the PS/ST, and two in the ST treatment groups. In all cases, migration or fracture of the stent graft led to recurrent pseudoaneurysm formation or erosion. Rupture occurred after a herald bleed in four cases. Once complication occurred, 10 of the 11 access sites had to be abandoned.
Significant life-threatening complication can arise when fracture and migration of the stent grafts used for treating AV access occur. Herald bleed with a previously placed stent graft may be a harbinger of future rupture. Complications appear less likely when stent grafts are used to treat stenosis; however, when complications occur, access site salvage is rare. Surgical revision in the case of pseudoaneurysm should be considered for access preservation.
血管内支架移植物用于治疗失败的动静脉（AV）通路。有报道称支架移植物具有优越性，并推荐将其作为一线治疗方法。我们注意到，我们的患者中与支架移植物相关的并发症数量有所增加。进行这项研究是为了评估这些并发症的严重程度及其对通路维护的影响。
我们回顾了过去 44 个月内因治疗透析通路失败而接受血管内支架移植物治疗的所有患者。对连续放置的 38 个支架移植物进行了一系列研究，以评估支架移植物的迁移、断裂、侵蚀、出血和破裂情况。回顾了病历以评估适应证、血流动力学稳定性、输血需求和结局。
在放置的 38 个支架移植物中，9 个用于治疗假性动脉瘤（PS），20 个用于治疗狭窄（ST），9 个用于治疗 PS/ST 复合病变。平均随访时间为 218.6 天。一期通畅率为 49%，辅助一期通畅率为 76%。11 名患者（28.9%）出现与迁移、断裂、侵蚀或破裂相关的并发症。其中 6 例发生在 PS 组，3 例发生在 PS/ST 组，2 例发生在 ST 治疗组。所有情况下，支架移植物的迁移或断裂导致复发性假性动脉瘤形成或侵蚀。4 例在预示性出血后发生破裂。一旦发生并发症，11 个通路中有 10 个不得不被废弃。
当用于治疗 AV 通路的支架移植物发生断裂和迁移时，可能会出现严重的危及生命的并发症。先前放置的支架移植物出现预示性出血可能是未来破裂的先兆。当支架移植物用于治疗狭窄时，并发症发生的可能性较小；然而，当并发症发生时，很少能保留通路。对于假性动脉瘤，应考虑手术修复以保留通路。
