Nassar George M, Beathard Gerald, Rhee Edward, Khan Abdul Jabbar, Nguyen Binh
Dialysis Access Management Centers, Nephrology Dialysis and Transplantation Associates, The Kidney Institute & Houston Methodist Hospital, Weill Cornell University, Houston, Texas - USA.
University of Texas Medical Branch, Galveston, Texas - USA.
J Vasc Access. 2017 Nov 17;18(6):482-487. doi: 10.5301/jva.5000770. Epub 2017 Jul 5.
Transposed basilic vein arteriovenous fistulas suffer from stenosis at their basilic angle of transposition (BAT). This lesion exhibits frequent recurrence after angioplasty. The primary goal of this study was to determine the effect of stent-graft placement on BAT lesion- and access-patency. The secondary goals were to determine the frequency of intervention pre- and post-stent placement and stent-associated stenosis.
Thirty-seven cases had stent-grafts placed at their BAT to manage stenosis. Cases served as their own controls by analyzing their lesion- and access-patency pre- and post-stent placement. Student's t-test was used for analysis of continuous variables. Categorical variables were evaluated by Fisher's exact test. Tests were considered significant when p was ≤0.05.
At 6 and 12 months, pre-stent lesion primary patency rates were 29% and 3%, and post-stent were 57% and 40%, respectively. Lesion primary assisted patency rates were 39% and 13%, and post-stent were 91% and 80%, respectively. At 6 and 12 months, pre-stent access primary patency rates were 29% and 3%, and post-stent were 26% and 19%, respectively. Pre-stent primary access assisted patency rates were 36% and 10%, and post-stent were 82% and 75%, respectively. Lesion intervention rates averaged 0.47/month pre-stent and 0.13/month post-stent. Access intervention rate averaged 0.50/month pre-stent, and 0.15/month post-stent. Stent-associated stenosis was seen in 23 cases.
Treatment of BAT stenosis with stent-grafts had positive impact on the target lesion and the dialysis access circuit.
转位贵要静脉动静脉内瘘在其转位的贵要静脉角（BAT）处存在狭窄。这种病变在血管成形术后常复发。本研究的主要目的是确定支架移植物置入对BAT病变和通路通畅性的影响。次要目的是确定支架置入前后的干预频率以及支架相关狭窄情况。
37例患者在其BAT处置入支架移植物以处理狭窄。通过分析支架置入前后的病变和通路通畅性，病例自身作为对照。采用学生t检验分析连续变量。分类变量通过Fisher精确检验进行评估。当p≤0.05时，检验被认为具有显著性。
在6个月和12个月时，支架置入前病变的初始通畅率分别为29%和3%，支架置入后分别为57%和40%。病变的初始辅助通畅率分别为39%和13%，支架置入后分别为91%和80%。在6个月和12个月时，支架置入前通路的初始通畅率分别为29%和3%，支架置入后分别为26%和19%。支架置入前通路的初始辅助通畅率分别为36%和10%，支架置入后分别为82%和75%。病变干预率在支架置入前平均为0.47/月，支架置入后为0.13/月。通路干预率在支架置入前平均为0.50/月，支架置入后为0.15/月。23例出现支架相关狭窄。
用支架移植物治疗BAT狭窄对目标病变和透析通路循环有积极影响。
