Bavare Charudatta S, Street Tiffany K, Peden Eric K, Davies Mark G, Naoum Joseph J
Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital , Houston, TX , USA.
Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA; Department of Surgery, Division of Vascular and Endovascular Surgery, Lebanese American University, Beirut, Lebanon.
Front Surg. 2017 Feb 27;4:13. doi: 10.3389/fsurg.2017.00013. eCollection 2017.
Not all newly created arteriovenous fistulas (AVFs) successfully mature and develop into a functioning access for hemodialysis. Percutaneous transluminal angioplasty (PTA) and balloon-assisted maturation (BAM) have been utilized to either treat flow-limiting stenoses or to promote and accelerate maturation. We hypothesized that unusable upper arm AVFs can be rescued by conversion to a functional access using the percutaneous placement of a stent graft (SG).
Clinical data on 12 patients with an early non-usable upper arm AVF underwent percutaneous revision using SGs. There were six brachial-cephalic, three brachial-basilic, and three brachial-brachial vein transposition AVFs.
All patients had either at least two or more stenoses (>2 cm) within the fistula conduit, or a long segment stenosis (>4 cm) in combination with shorter segment stenoses. Nine patients had failed PTA. Three patients had failed BAM at outside access centers. All patients were referred for failure to achieve access cannulation and concomitant hemodialysis through the AVF. SGs were placed retrograde toward the arterial anastomoses and ranged in diameter (6, 7, and 8 mm in four, seven, and one patients, respectively). The average length of the SG was 10 cm (range 5-15 cm). All SGs were post-balloon dilated at the time of placement. All AVFs were salvaged, and patients were able to maintain functional use of their access with cannulation occurring through the SG. The primary patency rate at 6 and 12 months was 91% [95% confidence interval (CI), 56-98%] and 65% (95% CI, 32-87%), respectively ( = 11 and 5 at risk, respectively). The secondary patency rate at 6 and 12 months was 100 and 72% (95% CI, 46-93%), respectively ( = 11 and 7 at risk, respectively).
This report outlines a successful initial experience using SGs to rescue, preserve, and convert an unusable upper arm AVF into a functioning hemodialysis access.
并非所有新创建的动静脉内瘘（AVF）都能成功成熟并发展成为用于血液透析的有效通路。经皮腔内血管成形术（PTA）和球囊辅助成熟术（BAM）已被用于治疗限流性狭窄或促进并加速成熟。我们推测，通过经皮置入支架移植物（SG）将不可用的上臂AVF转换为功能性通路，可以挽救这些内瘘。
12例早期不可用的上臂AVF患者接受了SG经皮修复治疗。其中有6例肱-头臂型、3例肱-贵要静脉型和3例肱-肱静脉转位型AVF。
所有患者在瘘管内均有至少两处或更多处狭窄（>2 cm），或存在长段狭窄（>4 cm）并伴有短段狭窄。9例患者PTA治疗失败。3例患者在外部通路中心BAM治疗失败。所有患者均因无法通过AVF进行通路穿刺及同步血液透析而前来就诊。SG逆行置入至动脉吻合口，直径分别为6 mm（4例患者）、7 mm（7例患者）和8 mm（1例患者）。SG的平均长度为10 cm（范围5 - 15 cm）。所有SG在置入时均进行了球囊后扩张。所有AVF均得以挽救，患者能够通过SG进行穿刺，维持通路的功能性使用。6个月和12个月时的初级通畅率分别为91% [95%置信区间（CI），56 - 98%]和65%（95% CI，32 - 87%）（分别有11例和5例处于风险中）。6个月和12个月时的次级通畅率分别为100%和72%（95% CI，46 - 93%）（分别有11例和7例处于风险中）。
本报告概述了使用SG挽救、保留并将不可用的上臂AVF转换为功能性血液透析通路的成功初步经验。
