Richmond Vascular Center, 173 Wadsworth Drive, North Chesterfield, VA 23236.
Richmond Vascular Center, 173 Wadsworth Drive, North Chesterfield, VA 23236.
J Vasc Interv Radiol. 2019 Nov;30(11):1779-1784. doi: 10.1016/j.jvir.2019.04.021. Epub 2019 Jul 3.
To report results of percutaneous costoclavicular bypass for symptomatic thoracic outlet or cephalic arch occlusion in patients with arteriovenous fistula.
A retrospective review of percutaneous costoclavicular bypass patients between 2014 and 2018 was performed. Stent grafts were placed subcutaneously over the clavicle from the fistula outflow (axillary or cephalic vein) into a jugular vein or collateral. The procedures were performed in patients who had exhausted or were not candidates for balloon dilation or intravascular stent placement.
Technical success was 100% (9/9) with resolution of symptoms in all patients. Indications were arm swelling in 67% (6/9), fistula dysfunction in 22% (2/7), and 1 enlarging aneurysm. The fistula outflow was cephalic in 67% (6/9) and axillary in 33% (3/9). The return vessel was external jugular in 78% (7/9) and internal jugular in 22% (2/9). Two overlapping Viabahn stent grafts were used in 88% of cases (7/8) and 3 stent grafts in 1 case. In the initial case, 2 Gore hybrid grafts were used. Stent graft diameter ranged from 9 mm to 13 mm. Mean follow-up was 852 ± 339 days (range, 488-1483 days). At 12 months and 24 months, primary patency was 67% and 67%, and secondary patency was 89% and 78%, respectively. Complications included late thrombosis and secondary infection. There were no anastomotic leaks or seromas associated with extravascular stent grafts.
The percutaneous costoclavicular bypass is a feasible option for thoracic outlet and cephalic arch occlusion in symptomatic dialysis patients.
报告经皮锁骨下旁路治疗动静脉瘘患者锁骨下出口或头臂弓阻塞的症状性结果。
对 2014 年至 2018 年期间进行的经皮锁骨下旁路患者进行回顾性分析。支架移植物从瘘管流出（腋或头静脉）皮下放置在锁骨下，进入颈内或侧支静脉。这些手术是在已经用尽或不适合球囊扩张或血管内支架放置的患者中进行的。
技术成功率为 100%（9/9），所有患者的症状均得到缓解。67%（6/9）的患者有手臂肿胀，22%（2/7）的患者有瘘管功能障碍，1 例患者有扩大的动脉瘤。瘘管流出在 67%（6/9）的患者为头静脉，33%（3/9）的患者为腋静脉。回流血管在 78%（7/9）的患者为颈外静脉，22%（2/9）的患者为颈内静脉。88%（7/8）的病例使用了 2 个重叠的 Viabahn 支架移植物，1 例使用了 3 个支架移植物。在最初的病例中，使用了 2 个 Gore 杂交移植物。支架移植物直径范围为 9 至 13 毫米。平均随访时间为 852±339 天（范围 488-1483 天）。在 12 个月和 24 个月时，原发性通畅率分别为 67%和 67%，继发性通畅率分别为 89%和 78%。并发症包括晚期血栓形成和继发性感染。没有与血管外支架移植物相关的吻合口漏或血清肿。
经皮锁骨下旁路是治疗症状性透析患者锁骨下出口和头臂弓阻塞的可行选择。
