Vascular Surgery Department, Clinique Jouvenet, Paris, France.
Interventional Angiography Department, Clinique Alleray-Labrouste, Paris, France.
J Vasc Surg. 2014 Jan;59(1):260-3. doi: 10.1016/j.jvs.2013.07.015. Epub 2013 Nov 5.
Use of the Amplatzer vascular plug (AVP; St. Jude Medical Inc, St. Paul, Minn) for percutaneous occlusion of a hemodialysis arteriovenous access (AVA) is an emerging practice, and only a few reports by radiologists have been published. We report here a multidisciplinary experience of this technique not only for AVA occlusion but also for flow reduction in selected patients.
This preliminary study includes a series of 20 plugs of different generations (I, II, and IV) used in 19 hemodialysis patients (two children, 17 adults). Of these, 15 AVAs were autologous fistulas located at the elbow, 4 were autologous forearm fistulas, and 1 was a brachial-basilic polytetrafluoroethylene graft. AVP deployment was through a 4F to 8F sheath, with oversizing from 30% to 50% to reduce the risk of migration. AVA occlusion (n = 14), by placing the AVP in the vein at its origin, was performed for central vein occlusion after unsuccessful percutaneous recanalization (n = 4), high flow (n = 2), hand ischemia (n = 3), successful kidney transplant (n = 1), and brachial-basilic or brachial-brachial fistula second-stage superficialization technical failure (n = 4). Vein/polytetrafluoroethylene grafts were not removed. AVA flow reduction (n = 6), by placing the AVP in the radial artery, was performed for well-tolerated high flow (n = 3) or high flow associated with distal ischemia (n = 3). All patients underwent a postoperative evaluation at 6-month intervals that included a clinical examination and duplex scan.
AVA occlusion or flow reduction was successfully achieved in all patients. Ischemia persisted in one patient and a revascularization with a distal bypass was necessary. Mean follow-up was 1.2 ± 0.8 years (range, 2 months-2.9 years). No plug migration, access revascularization, or other complication was observed.
The results of this short preliminary study suggest that plug insertion for occlusion or for flow reduction in a hemodialysis AVA constitutes a reasonable alternative to coil insertion or to open surgery in selected patients.
使用 Amplatzer 血管塞（AVP；圣犹达医疗公司，明尼苏达州圣保罗市）经皮闭塞血液透析动静脉通路（AVA）是一种新兴的实践，只有少数放射科医生的报告已经发表。我们在此报告这项技术的多学科经验，不仅用于 AVA 闭塞，而且还用于选定患者的流量减少。
这项初步研究包括在 19 名血液透析患者（2 名儿童，17 名成人）中使用的不同代（I、II 和 IV）的 20 个塞子。其中，15 个 AVA 是位于肘部的自体瘘管，4 个是自体前臂瘘管，1 个是肱动脉-尺动脉聚四氟乙烯移植物。AVP 部署通过 4F 至 8F 鞘，过度扩张 30%至 50%，以降低迁移风险。AVA 闭塞（n=14），通过将 AVP 放置在静脉的起源处，在经皮再通不成功后进行中心静脉闭塞（n=4）、高流量（n=2）、手部缺血（n=3）、成功的肾移植（n=1）和肱动脉-尺动脉或肱动脉-肱动脉瘘第二阶段浅表化技术失败（n=4）。静脉/聚四氟乙烯移植物未被移除。AVA 流量减少（n=6），通过将 AVP 放置在桡动脉中，用于耐受良好的高流量（n=3）或高流量伴远端缺血（n=3）。所有患者均在 6 个月的间隔内进行术后评估，包括临床检查和双功能超声检查。
所有患者均成功实现 AVA 闭塞或流量减少。一名患者持续存在缺血，需要进行远端旁路再血管化。平均随访时间为 1.2±0.8 年（范围为 2 个月至 2.9 年）。未观察到塞子迁移、通路再血管化或其他并发症。
这项短期初步研究的结果表明，在血液透析 AVA 中插入塞子进行闭塞或流量减少，对于选定的患者来说，是线圈插入或开放手术的合理替代方案。
