Chong Tze Tec, Yap Hao Yun, Tan Chieh Suai, Lee Qingwei Shaun, Chan Sze Ling, Wee Ian Jun Yan, Tang Tjun Yip
Department of Vascular Surgery, Singapore General Hospital, Singapore.
Department of Interventional Nephrology, Singapore General Hospital, Singapore.
Vasc Specialist Int. 2020 Mar 31;36(1):21-27. doi: 10.5758/vsi.2020.36.1.21.
Central venous stenosis is a recurring problem affecting dialysis access patency. Increasing evidence suggests that the use of drug-coated balloons (DCBs) improves target lesion primary patency (TLPP) in dialysis access. However, few studies have investigated the use of DCBs specifically in central venous stenosis. Thus, this study presents our initial experience with DCBs in the central vein of a dialysis access circuit.
This is a retrospective cohort study of all hemodialysis patients who underwent central vein angioplasty with DCB between February 2017 and March 2018 at Singapore General Hospital. We compared the primary patency post DCB angioplasty to the primary patency of the patient's previous plain old balloon angioplasty (POBA).
We observed a 100% anatomic and procedural success rate with no complications. The median follow-up period was 151 days (interquartile range, 85.5-234 days) and no patients were lost to follow-up. The 30- and 90-day TLPPs after DCB were 93.3% and 75.7%, respectively. The mean primary patency in our study group post-DCB during the follow-up period was 164 days (vs. 140 days in the POBA group). However, no statistically significant difference was detected.
DCB showed a similar TLPP to that for POBA in treating central venous stenosis with a trend toward a longer re-intervention-free period for DCB. However, there were numerous confounding factors and a well-designed randomized controlled trial is warranted to assess the true utility of DCB in treating central venous stenosis.
中心静脉狭窄是影响透析通路通畅性的一个反复出现的问题。越来越多的证据表明，使用药物涂层球囊（DCB）可提高透析通路中靶病变的初始通畅率（TLPP）。然而，很少有研究专门探讨DCB在中心静脉狭窄中的应用。因此，本研究介绍了我们在透析通路回路中心静脉使用DCB的初步经验。
这是一项回顾性队列研究，研究对象为2017年2月至2018年3月在新加坡总医院接受DCB中心静脉血管成形术的所有血液透析患者。我们将DCB血管成形术后的初始通畅率与患者之前单纯球囊血管成形术（POBA）的初始通畅率进行了比较。
我们观察到解剖和手术成功率为100%，无并发症。中位随访期为151天（四分位间距，85.5 - 234天），无患者失访。DCB术后30天和90天的TLPP分别为93.3%和75.7%。在随访期间，我们研究组DCB术后的平均初始通畅时间为164天（POBA组为140天）。然而，未检测到统计学上的显著差异。
在治疗中心静脉狭窄方面，DCB的TLPP与POBA相似，且DCB有延长无再次干预期的趋势。然而，存在众多混杂因素，有必要进行一项设计良好的随机对照试验来评估DCB在治疗中心静脉狭窄中的真正效用。
