Department of Radiology, Division of Interventional Radiology, Izmir Katip Celebi University, Faculty of Medicine, Izmir Turkey.
Division of Interventional Radiology, Department of Radiology, Koc University, Faculty of Medicine, Istanbul Turkey.
Diagn Interv Imaging. 2019 Sep;100(9):485-492. doi: 10.1016/j.diii.2019.03.011. Epub 2019 Apr 2.
The purpose of this study was to compare the primary and secondary patency rates of percutaneous transluminal angioplasty (PTA) alone with those of metallic stent placement in patients with hemodialysis access and central venous occlusion (CVO) and to compare the respective effects of nitinol and stainless-steel stents on patency. MATERıALS AND METHODS: A total of 150 consecutive patients with hemodialysis access who underwent endovascular treatment for symptomatic CVO with ipsilateral functioning hemodialysis access were evaluated. There were 67 men and 83 women with a mean age of 56.2±15.2 (SD) years (range: 15-86 years). The primary endovascular treatment of CVO was PTA alone. Stent placement either with nitinol or stainless-steel stents was performed as a bailout procedure. The results were analyzed on a per patient basis.
Technical success was achieved in 141/150 patients (94%). Of the 141 patients, 109 (77%) underwent PTA alone and 32 (23%) underwent stent placement. The mean number of interventions in the stent group [4.3±2.5 (SD)] was significantly higher than that in the PTA alone group [2.6±2.8 (SD)] (P=0.002). The primary patency rates at 12, 24, and 60 months for the stent group (58.7%, 41.9%, and 27.9%, respectively) were significantly higher than those in the PTA alone group (42.4%, 36.3%, and 20.2%, respectively) (P=0.036). Secondary patency rates at 12, 24, and 60 months for the stent group (87.6%, 80.7%, and 50.3%, respectively) were significantly greater than those in the PTA alone group (68.4%, 56%, and 38.6%, respectively) (P=0.046). Furthermore, the primary patency rates at 6 and 12 months in the nitinol stent group (89% and 80.9%, respectively) were significantly greater than those in the stainless-steel stent group (78.8% and 38.4%, respectively) (P=0.007). The secondary patency rates at 6, 12 and 24 months for the nitinol stent group (92.8%, 87.7% and 65.8%, respectively) were significantly greater than those in the stainless-steel stent group (85.7%, 76.2% and 65.3%, respectively) (P=0.011). CONCLUSıON: Although PTA alone is an effective interventional treatment strategy of CVO in short term, stent placement yields greater primary and secondary patency rates in the long-term. But the mean number of interventions per vein after stenting is significantly higher. Close follow-up and multiple re-interventions are necessary to ensure long-term patency.
本研究旨在比较经皮腔内血管成形术（PTA）单独治疗与金属支架置入治疗血液透析通路和中心静脉阻塞（CVO）患者的一级和二级通畅率，并比较镍钛诺和不锈钢支架对通畅率的影响。
共评估了 150 例因症状性 CVO 而行血管内治疗的有血液透析通路的连续患者，这些患者的同侧有功能的血液透析通路。其中 67 例为男性，83 例为女性，平均年龄为 56.2±15.2（SD）岁（范围：15-86 岁）。CVO 的主要血管内治疗是 PTA 单独治疗。支架置入术（镍钛诺或不锈钢支架）作为抢救治疗。结果以患者为基础进行分析。
150 例患者中有 141 例（94%）获得了技术成功。在 141 例患者中，109 例（77%）接受了 PTA 单独治疗，32 例（23%）接受了支架置入术。支架组的平均干预次数[4.3±2.5（SD）]明显高于 PTA 单独组[2.6±2.8（SD）]（P=0.002）。支架组的一级通畅率在 12、24 和 60 个月时分别为 58.7%、41.9%和 27.9%，明显高于 PTA 单独组的 42.4%、36.3%和 20.2%（P=0.036）。支架组的二级通畅率在 12、24 和 60 个月时分别为 87.6%、80.7%和 50.3%，明显高于 PTA 单独组的 68.4%、56%和 38.6%（P=0.046）。此外，镍钛诺支架组在 6 和 12 个月时的一级通畅率（分别为 89%和 80.9%）明显高于不锈钢支架组（分别为 78.8%和 38.4%）（P=0.007）。镍钛诺支架组在 6、12 和 24 个月时的二级通畅率（分别为 92.8%、87.7%和 65.8%）明显高于不锈钢支架组（分别为 85.7%、76.2%和 65.3%）（P=0.011）。
尽管 PTA 单独治疗是 CVO 的有效短期介入治疗策略，但支架置入术在长期内可获得更高的一级和二级通畅率。但是支架置入后每条静脉的平均干预次数明显更高。为了确保长期通畅，需要密切随访和多次再介入。
