Bautista Andre B, Suhocki Paul V, Pabon-Ramos Waleska M, Miller Michael J, Smith Tony P, Kim Charles Y
Division of Vascular and Interventional Radiology, Duke University Medical Center, Box 3808, 2311 Erwin Rd., Durham, NC 27710.
Division of Vascular and Interventional Radiology, Duke University Medical Center, Box 3808, 2311 Erwin Rd., Durham, NC 27710.
J Vasc Interv Radiol. 2015 Nov;26(11):1673-9. doi: 10.1016/j.jvir.2015.08.008. Epub 2015 Sep 26.
To determine postintervention patency rates after endovascular interventions on intragraft stenosis within failing prosthetic arteriovenous (AV) grafts, as well as predictors of patency.
Retrospective review of percutaneous interventions on prosthetic AV grafts presenting with first-time intragraft stenoses over a 7-year period revealed 183 patients (81 male; mean age, 59.7 y). "Intragraft" was defined as 2 cm or more from the arterial or venous anastomosis. Procedural imaging was retrospectively reviewed. Patency rates were estimated by Kaplan-Meier test. Predictors of patency were calculated by Cox proportional-hazards model.
Two-hundred twenty-nine intragraft stenoses were identified in 183 grafts. Intragraft stenoses were treated at a median of 20.7 months (interquartile range, 12.0-33.9 mo) after graft creation. Graft thrombosis was present in 62%. The anatomic success rate of angioplasty was 85%. Fifteen percent required stent or stent-graft deployment because of inadequate response to angioplasty. A concurrent nonintragraft stenosis within the access circuit was identified in 76% of grafts. At 3, 6, and 12 months, postintervention primary patency rates were 56%, 40%, and 23%, respectively. Secondary patency rates were 84%, 77%, and 67%, respectively. The lesion-specific patency rates were 89, 75%, and 63%, respectively. Graft thrombosis (hazard ratio [HR], 1.43; P = .048) and concurrent nonintragraft lesion (HR, 1.51; P = .047) were independent negative predictors of primary patency. Graft thrombosis (HR, 1.81; P = .029) was a negative predictor of lesion patency, and stent or stent-graft deployment (HR, 0.42; P = .045) was a positive predictor of lesion patency.
Endovascular interventions on intragraft stenoses resulted in primary, secondary, and lesion-specific patency rates of 40%, 77%, and 75%, respectively, at 6 months. Stent or stent-graft deployment may prolong lesion patency.
确定对功能衰竭的人工动静脉（AV）移植物内移植物狭窄进行血管内介入治疗后的干预后通畅率以及通畅的预测因素。
回顾性分析7年间首次出现移植物内狭窄的人工AV移植物的经皮介入治疗情况，共纳入183例患者（81例男性；平均年龄59.7岁）。“移植物内”定义为距动脉或静脉吻合口2 cm或更远。对手术影像进行回顾性分析。采用Kaplan-Meier检验估计通畅率。通过Cox比例风险模型计算通畅的预测因素。
在183个移植物中发现229处移植物内狭窄。移植物内狭窄在移植物创建后的中位时间为20.7个月（四分位间距，12.0 - 33.9个月）进行治疗。62%存在移植物血栓形成。血管成形术的解剖成功率为85%。15%因血管成形术反应不佳需要置入支架或支架移植物。76%的移植物在通路循环内存在并发的非移植物内狭窄。在3、6和12个月时，干预后的初次通畅率分别为56%、40%和23%。二次通畅率分别为84%、77%和67%。病变特异性通畅率分别为89%、75%和63%。移植物血栓形成（风险比[HR]，1.43；P = 0.048）和并发的非移植物内病变（HR，1.51；P = 0.047）是初次通畅的独立负性预测因素。移植物血栓形成（HR，1.81；P = 0.029）是病变通畅的负性预测因素，而支架或支架移植物置入（HR，0.42；P = 0.045）是病变通畅的正性预测因素。
对移植物内狭窄进行血管内介入治疗后，6个月时的初次、二次和病变特异性通畅率分别为40%、77%和75%。置入支架或支架移植物可能延长病变通畅时间。
