de Graaf Rick
Department of Radiology, Maastricht University Medical Centre, Maastricht - The Netherlands.
J Vasc Access. 2017 Mar 6;18(Suppl. 1):74-76. doi: 10.5301/jva.5000704. Epub 2017 Mar 5.
Swing-segment lesions are a fairly common reason for access failure and predispose to repeated interventions. The pathophysiology, hemodynamic circumstances and the primary intervention might all play a role in early recurrence. Mainly, percutaneous transluminal angioplasty (PTA), bare metal stenting and stent graft implantation have been performed to prolong lesion patency and access circuit patency. The available data on endovascular treatment of swing-segment lesions are scarce, heterogeneous and of poor quality. Moreover, with the continuous evolution of endovascular techniques and introduction of new devices there is a risk of increasing device-specific investigations. In the meantime, PTA is easily discarded in favor of novel stents and stent grafts. However, PTA might still have an important position in the overall treatment strategy to postpone loss of the vascular access site. However, without optimal post-interventional imaging, true PTA results remain obscure and indications for additional stent (graft) implantation unclear. Currently, it seems that different devices are utilized to prolong lesion patency rather than access circuit patency. Obviously, more randomized controlled trials and well-structured multicenter registries may be capable of determining a superior treatment modality for a specific lesion. However, it might be more accurate to identify the optimal sequence of interventions by which the lifespan of the access site is maintained as long as possible.
摆动段病变是通路失败的常见原因，且易导致反复干预。病理生理学、血流动力学情况及初次干预可能都在早期复发中起作用。主要通过经皮腔内血管成形术（PTA）、裸金属支架置入术和支架移植物植入术来延长病变通畅时间和通路循环通畅时间。关于摆动段病变血管内治疗的现有数据稀少、异质性强且质量差。此外，随着血管内技术的不断发展和新器械的引入，存在增加器械特异性研究的风险。与此同时，PTA很容易被新型支架和支架移植物取代。然而，PTA在推迟血管通路部位丧失的整体治疗策略中可能仍占有重要地位。然而，若没有最佳的介入后成像，真正的PTA结果仍不明确，额外植入支架（移植物）的指征也不清楚。目前，似乎使用不同的器械来延长病变通畅时间而非通路循环通畅时间。显然，更多的随机对照试验和结构良好的多中心注册研究或许能够确定针对特定病变的更优治疗方式。然而，确定能尽可能延长通路部位使用寿命的最佳干预顺序可能更为准确。
