Division of Cardiovascular Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
J Vasc Surg Venous Lymphat Disord. 2020 Mar;8(2):195-204. doi: 10.1016/j.jvsv.2019.08.017.
Central venous occlusive disease is a critical complication in long-term hemodialysis patients with arteriovenous (AV) dialysis circuits. The purpose of this retrospective, single-arm cohort study was to evaluate the effectiveness of an abdominal aortic aneurysm (AAA) contralateral leg endoprosthesis to treat symptomatic central venous occlusive diseases in patients with chronic hemodialysis.
A prospective cohort study included 60 patients on hemodialysis presenting with central venous stenosis or occlusion, who were treated with a Gore Excluder AAA contralateral leg stent graft between December 2013 and July 2018. Follow-up angiography was obtained at 3, 6, and 12 months. The outcomes and duration of primary circuit and target site patency were measured from the time of the stent graft implantation to the first reintervention for AV circuit dysfunction and target site restenosis. Secondary patency was calculated from stent graft implantation to the point when AV access was no longer attainable.
Circuit primary patency rate was 54.9% at 1 year of Gore Excluder AAA contralateral leg or iliac extender stent grafts, implanted in 60 hemodialysis patients with central vein occlusive disease. Cumulative target site primary patency rate was 88.3% at 1 year. Secondary patency rate was 95% during follow-up. Patients with concomitant lesions had a significantly higher risk of circuit primary patency dysfunction.
Treatment of central vein obstructions in hemodialysis patients with stent grafts has been appealing owing to the tapered shape with a larger diameter and the availability of various lengths.
中心静脉阻塞性疾病是长期血液透析患者动静脉（AV）透析回路的严重并发症。本回顾性单臂队列研究的目的是评估腹主动脉瘤（AAA）对侧下肢覆膜支架移植物治疗慢性血液透析患者症状性中心静脉阻塞性疾病的疗效。
一项前瞻性队列研究纳入了 2013 年 12 月至 2018 年 7 月期间因中心静脉狭窄或闭塞而接受 Gore Excluder AAA 对侧下肢支架移植物治疗的 60 例血液透析患者。在 3、6 和 12 个月时获得随访血管造影。从支架移植物植入到 AV 回路功能障碍和靶部位再狭窄的首次再介入的时间来测量主要回路和靶部位通畅的结果和持续时间。从支架移植物植入到无法再获得 AV 通路的时间来计算次要通畅率。
在植入 60 例中心静脉阻塞性疾病的血液透析患者中，Gore Excluder AAA 对侧下肢或髂 extender支架移植物的 1 年电路一级通畅率为 54.9%。1 年时靶部位一级通畅率累积为 88.3%。在随访期间，二级通畅率为 95%。同时存在病变的患者电路一级通畅功能障碍的风险显著增加。
由于支架移植物具有锥形形状和更大的直径以及各种长度，因此治疗血液透析患者的中心静脉阻塞症很有吸引力。
