El Kassem Mohamad, Alghamdi Issam, Vazquez-Padron Roberto I, Asif Arif, Lenz Oliver, Sanjar Tina, Fayad Fadi, Salman Loay
Interventional Nephrology Section, Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, FL; Vascular Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL; Division of Nephrology, Albany Medical College, Albany, NY; Internal Medicine Hospitalist Division, South Miami Hospital, South Miami, FL.
Interventional Nephrology Section, Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, FL; Vascular Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL; Division of Nephrology, Albany Medical College, Albany, NY; Internal Medicine Hospitalist Division, South Miami Hospital, South Miami, FL.
Adv Chronic Kidney Dis. 2015 Nov;22(6):453-8. doi: 10.1053/j.ackd.2015.02.001.
Vascular stenosis is most often the culprit behind hemodialysis vascular access dysfunction, and although percutaneous transluminal angioplasty remains the gold standard treatment for vascular stenosis, over the past decade the use of stents as a treatment option has been on the rise. Aside from the 2 Food and Drug Administration-approved stent grafts for the treatment of venous graft anastomosis stenosis, use of all other stents in vascular access dysfunction is off-label. Kidney Disease Outcomes Quality Initiative recommends limiting stent use to specific conditions, such as elastic lesions and recurrent stenosis; otherwise, additional adapted indications are in procedure-related complications, such as grade 2 and 3 hematomas. Published reports have shown the potential use of stents in a variety of conditions leading to vascular access dysfunction, such as venous graft anastomosis stenosis, cephalic arch stenosis, central venous stenosis, dialysis access aneurysmal elimination, cardiac implantable electronic device-induced stenosis, and thrombosed arteriovenous grafts. Although further research is needed for many of these conditions, evidence for recommendations has been clear in some; for instance, we know now that stents should be avoided along cannulation sites and should not be used in eliminating dialysis access aneurysms. In this review article, we evaluate the available evidence for the use of stents in each of the aforementioned conditions leading to hemodialysis vascular access dysfunctions.
血管狭窄往往是血液透析血管通路功能障碍的罪魁祸首，尽管经皮腔内血管成形术仍是血管狭窄的金标准治疗方法，但在过去十年中，使用支架作为一种治疗选择的情况一直在增加。除了美国食品药品监督管理局批准的用于治疗静脉移植物吻合口狭窄的2种支架移植物外，在血管通路功能障碍中使用的所有其他支架均为超适应证使用。改善全球肾脏病预后组织建议将支架的使用限制在特定情况下，如弹性病变和复发性狭窄；否则，其他适用的适应证是与手术相关的并发症，如2级和3级血肿。已发表的报告显示，支架在导致血管通路功能障碍的各种情况下具有潜在用途，如静脉移植物吻合口狭窄、头臂弓狭窄、中心静脉狭窄、透析通路动脉瘤消除、心脏植入式电子设备引起的狭窄以及血栓形成的动静脉移植物。尽管其中许多情况还需要进一步研究，但在某些情况下推荐的证据已经很明确；例如，我们现在知道，应避免在插管部位使用支架，并且不应使用支架来消除透析通路动脉瘤。在这篇综述文章中，我们评估了在上述导致血液透析血管通路功能障碍的每种情况下使用支架的现有证据。
