Aurshina Afsha, Hingorani Anil, Marks Natalie, Ascher Enrico
Vascular Institute of New York, Brooklyn, USA.
Vascular. 2018 Aug;26(4):368-371. doi: 10.1177/1708538117742829. Epub 2017 Nov 23.
Objective Endovascular stent graft repair for exclusion of pseudoaneurysm is currently being explored to replace open surgical repair as current management. The objective of the study was to evaluate the clinical safety and efficacy of endovascular stent graft intervention in pseudoaneurysms complicating arteriovenous reconstructions in patients on chronic hemodialysis. Methods A retrospective analysis of all pseudoaneurysms treated with stent grafts at our institution over a period of five years was performed. The indications for endovascular intervention included bleeding from the pseudoaneurysm, infection, and significant skin compromise overlying the pseudoaneurysm or combination of the above. The rates of technical success, complication, and primary patency were measured at one-week, one-month, and six-month follow-up. Results A total of 33 endovascular stent graft interventions in 29 patients were performed for the treatment of pseudoaneurysms. The average age of patients was 68 years (range 31-90 years), with 13 female. Diabetes and hypertension were present in 15 and 22 patients, respectively. In eight patients, there was evidence of active infection at the fistula site. The choice of stent grafts include Viabahn ( n = 31), Wallgraft ( n = 1), and i-Cast ( n = 1). The initial technical success rate was 94%. The two failed interventions included occlusion of inflow artery with immediate conversion to open procedure ( n = 1) and incomplete pseudoaneurysm exclusion ( n = 1). Primary patency at one month and six months was 83 and 60%, respectively. An additional balloon angioplasty of outflow tract or central stenosis was performed in 18 cases (54%). The explanation of stent grafts due to persistent or recurrent bacteremia/site infection was required in four out of eight patients. The average time to explanation was 93 days (range 6-204 days). Conclusion The stent graft implantation is a safe, minimally invasive and efficient way to control and manage arteriovenous accesses with pseudoaneurysms. In the presence of infection, this approach may be less durable.
目的 目前正在探索采用血管内支架移植物修复术来排除假性动脉瘤，以取代现行的开放性手术修复作为当前的治疗方法。本研究的目的是评估血管内支架移植物介入治疗慢性血液透析患者动静脉重建术中并发假性动脉瘤的临床安全性和疗效。方法 对我院5年内所有接受支架移植物治疗的假性动脉瘤进行回顾性分析。血管内介入治疗的指征包括假性动脉瘤出血、感染、假性动脉瘤上方明显的皮肤损害或上述情况的组合。在1周、1个月和6个月的随访中测量技术成功率、并发症发生率和原发性通畅率。结果 共对29例患者进行了33次血管内支架移植物介入治疗假性动脉瘤。患者的平均年龄为68岁（范围31 - 90岁），其中女性13例。15例和22例患者分别患有糖尿病和高血压。8例患者在瘘管部位有活动性感染的证据。支架移植物的选择包括Viabahn（n = 31）、Wallgraft（n = 1）和i-Cast（n = 1）。初始技术成功率为94%。两次失败的介入治疗包括流入动脉闭塞并立即转为开放手术（n = 1）和假性动脉瘤排除不完全（n = 1）。1个月和6个月时的原发性通畅率分别为83%和60%。18例（54%）患者进行了流出道或中心狭窄的额外球囊血管成形术。8例患者中有4例因持续性或复发性菌血症/部位感染需要取出支架移植物。取出的平均时间为93天（范围6 - 204天）。结论 支架移植物植入是控制和管理伴有假性动脉瘤的动静脉通路的一种安全、微创且有效的方法。在存在感染的情况下，这种方法可能耐久性较差。
