Ehrie Jarrod M, Sammarco Therese E, Chittams Jesse L, Trerotola Scott O
Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine, University of Pennsylvania, 1 Silverstein, 3400 Spruce St., Philadelphia, PA 19104.
Biostatistics Consulting Unit, Office of Nursing Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
J Vasc Interv Radiol. 2017 Oct;28(10):1409-1414. doi: 10.1016/j.jvir.2017.07.006. Epub 2017 Aug 18.
To determine the frequency of new-onset symptoms of central venous stenosis (CVS) after percutaneous transluminal angioplasty (PTA) of a hemodialysis access-related stenosis in patients with previously asymptomatic CVS and to identify risk factors for this phenomenon.
Retrospective review was performed of patients treated with PTA for an access-related stenosis (excluding central vein interventions) between 2001 and 2016 who returned within 3 months with symptoms of CVS (ie, "unmasking"): 39 patients met these criteria. A control group of 122 patients who had untreated asymptomatic CVS and did not experience unmasking was selected. Fistulograms were graded for degree of CVS. A total of 51% of the unmasked group was male, with an average age of 65 years; 57% of the control group was male, with an average age of 63 years.
The incidence of unmasking among patients with untreated asymptomatic CVS was 4.9%. A total of 90% of the unmasked group (35 of 39) had upper-arm access, compared with 77% of the control group (94 of 122; P = .017). A total of 28% of unmasked-group patients (11 of 39) underwent thrombectomy, vs 4% of controls (5 of 122; P < .0001). A total of 54% of unmasked-group patients (21 of 39) had significant brachiocephalic vein stenosis, vs 26% of controls (32 of 122; P = .001). A total of 8% of unmasked-group patients (3 of 39) had superior vena cava stenosis, vs none of the 122 controls (P = .01). A total of 64% of unmasked-group patients (25 of 39) had extensive collateral vessels, vs 24% of controls (29 of 122; P < .0001).
The incidence of unmasking of asymptomatic CVS is low. Prophylactic treatment of asymptomatic CVS therefore remains generally inadvisable. However, patients undergoing declotting with extensive collateral vessels might warrant treatment of asymptomatic CVS.
确定既往无症状的中心静脉狭窄（CVS）患者在接受经皮腔内血管成形术（PTA）治疗血液透析通路相关狭窄后出现CVS新发症状的频率，并识别这一现象的危险因素。
对2001年至2016年间接受PTA治疗通路相关狭窄（不包括中心静脉干预）且在3个月内出现CVS症状（即“症状暴露”）的患者进行回顾性研究：39例患者符合这些标准。选取122例无症状CVS且未出现症状暴露的患者作为对照组。对静脉造影的CVS程度进行分级。症状暴露组中51%为男性，平均年龄65岁；对照组中57%为男性，平均年龄63岁。
未治疗的无症状CVS患者中症状暴露的发生率为4.9%。症状暴露组中90%（39例中的35例）有上臂通路，而对照组为77%（122例中的94例；P = 0.017）。症状暴露组中有28%（39例中的11例）的患者接受了血栓切除术，而对照组为4%（122例中的5例；P < 0.0001）。症状暴露组中有54%（39例中的21例）有显著的头臂静脉狭窄，而对照组为26%（122例中的32例；P = 0.001）。症状暴露组中有8%（39例中的3例）有上腔静脉狭窄，而122例对照组中均无（P = 0.01）。症状暴露组中有64%（39例中的25例）有广泛的侧支血管，而对照组为24%（122例中的29例；P < 0.0001）。
无症状CVS症状暴露的发生率较低。因此，一般仍不建议对无症状CVS进行预防性治疗。然而，接受去凝治疗且有广泛侧支血管的患者可能需要对无症状CVS进行治疗。
