You Seulgi, Won Je Hwan, Oh Chang-Kwon, Lee Su Hyung, Shim Jong Joon, Kim Jinoo
Departments of Radiology, 164, World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 443-380, Republic of Korea.
Surgery, Ajou University School of Medicine, 164, World Cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do 443-380, Republic of Korea.
J Vasc Interv Radiol. 2016 Dec;27(12):1878-1884. doi: 10.1016/j.jvir.2016.07.022. Epub 2016 Sep 28.
To assess the feasibility and outcome of transjugular access for endovascular treatment of immature arteriovenous fistulae (AVFs).
Between August 2013 and January 2016, 90 patients (mean age, 64.5 y ± 12.8) underwent endovascular treatment of immature AVFs via transjugular access. The mean age of fistulae was 3.3 months ± 1.8. Total procedure time and technical and clinical success rates of endovascular procedures were assessed. Primary and secondary patency rates were calculated according to the Kaplan-Meier method, and complications were assessed.
All patients had inflow lesions, among which 19 (21.1%) had occlusions. The juxtaanastomotic segment was the most common site (44.3%). Transjugular access was successful in 83 patients (92.2%), and 7 required additional standard or transarterial access. The mean procedure time was 36.5 minutes. Technical and clinical success rates were 98.9% and 90.5%, respectively. Mean primary and secondary patency durations were 14.3 months ± 1.7 and 31.0 months ± 0.7, respectively. Primary patency rates at 3, 6, and 12 months were 84.4%, 67.3%, and 48.8%, respectively. Secondary patency rates at 6 and 18 months were 98.6% and 95.5%, respectively. Venous rupture occurred as a result of balloon inflation in 9 patients (10%), and was managed by balloon tamponade. There were no complications related to transjugular access during a mean follow-up period of 12.6 months.
Transjugular access for angioplasty of immature AVFs is feasible and safe. Potential problems associated with access in the outflow vein could be avoided by transjugular access.
评估经颈静脉途径对未成熟动静脉瘘（AVF）进行血管内治疗的可行性及治疗效果。
2013年8月至2016年1月期间，90例患者（平均年龄64.5岁±12.8岁）经颈静脉途径对未成熟AVF进行血管内治疗。瘘的平均年龄为3.3个月±1.8个月。评估血管内治疗的总操作时间以及技术成功率和临床成功率。根据Kaplan-Meier法计算初级和次级通畅率，并评估并发症。
所有患者均有流入道病变，其中19例（21.1%）存在闭塞。吻合口旁段是最常见的部位（44.3%）。83例患者（92.2%）经颈静脉途径成功，7例需要额外的标准或经动脉途径。平均操作时间为36.5分钟。技术成功率和临床成功率分别为98.9%和90.5%。初级和次级通畅的平均持续时间分别为14.3个月±1.7个月和31.0个月±0.7个月。3个月、6个月和12个月时的初级通畅率分别为84.4%、67.3%和48.8%。6个月和18个月时的次级通畅率分别为98.6%和95.5%。9例患者（10%）因球囊扩张导致静脉破裂，通过球囊压迫处理。在平均12.6个月的随访期内，未发生与经颈静脉途径相关的并发症。
经颈静脉途径对未成熟AVF进行血管成形术是可行且安全的。经颈静脉途径可避免与流出静脉穿刺相关的潜在问题。
