Fotiadis Nicos, Shawyer Andrew, Namagondlu Girish, Iyer Arun, Matson Matthew, Yaqoob Muhammad Magdi
Interventional Radiology Department, The Royal London Hospital, London - UK.
J Vasc Access. 2014 Jan-Feb;15(1):5-11. doi: 10.5301/jva.5000161. Epub 2013 Aug 9.
Repeated needle punctures of arteriovenous hemodialysis grafts can lead to the development of pseudoaneurysms. As they enlarge, graft pseudoaneurysms are associated with significant morbidity and require treatment. We present our single-center experience using stent grafts in selected patients to exclude symptomatic hemodialysis graft pseudoaneurysms.
Between March 2007 and December 2010, 11 consecutive patients (7 men and 4 women, mean age 57 years) underwent percutaneous endovascular repair of symptomatic hemodialysis access graft pseudoaneurysms. Indications for treatment were rapidly enlarging pseudoaneurysm in 5 patients, high venous pressures, limb edema and pseudoaneurysm in 3, skin breakdown over the pseudoaneurysm site in 2 and acute rupture and bleeding in 1 patient. No patient was lost to follow-up.
Technical success across the 11 patients was 90.9%. The patient who presented with rupture required ligation of the access due to continuous bleeding after stent graft insertion. Balloon angioplasty of a separate hemodynamically significant stenosis at the time of stent graft insertion was performed in 7 of 11 (63.6%) patients. The primary access patency rates were 72.7% (95% CI of 0.390-0.939) at 3 months and 36.4% (95% CI 0.109-0.692) at 6 months. Secondary access patency rates were 72.7% at 6 months (95% CI 0.233-0.832). There were no procedure-related complications. Mean follow-up was 9 months (range 2-29 months).
Endovascular treatment of symptomatic hemodialysis graft pseudoaneurysms is safe and effective with similar patency rates to surgical approaches. Importantly, this approach allows aggressive management of associated access circuit stenoses at the same time and avoids interval tunneled dialysis line insertion.
反复对动静脉血液透析移植物进行针刺可导致假性动脉瘤形成。随着假性动脉瘤增大，移植物假性动脉瘤会引发严重并发症，需要进行治疗。我们介绍在特定患者中使用覆膜支架排除有症状的血液透析移植物假性动脉瘤的单中心经验。
2007年3月至2010年12月，连续11例患者（7例男性，4例女性，平均年龄57岁）接受了经皮血管腔内修复有症状的血液透析通路移植物假性动脉瘤。治疗指征包括5例假性动脉瘤迅速增大，3例伴有高静脉压、肢体水肿和假性动脉瘤，2例假性动脉瘤部位皮肤破损，1例急性破裂出血。无患者失访。
11例患者的技术成功率为90.9%。出现破裂的患者在植入覆膜支架后因持续出血需要结扎通路。11例患者中有7例（63.6%）在植入覆膜支架时对另一处具有血流动力学意义的严重狭窄进行了球囊血管成形术。3个月时的初次通路通畅率为72.7%（95%可信区间0.390 - 0.939），6个月时为36.4%（95%可信区间0.109 - 0.692）。6个月时的二次通路通畅率为72.7%（95%可信区间0.233 - 0.832）。无手术相关并发症。平均随访9个月（范围2 - 29个月）。
对有症状的血液透析移植物假性动脉瘤进行血管腔内治疗是安全有效的，通畅率与手术方法相似。重要的是，这种方法能够同时积极处理相关通路的狭窄，避免了临时置入隧道式透析导管。
