Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu.
College of Medicine, National Taiwan University, Taipei.
J Vasc Access. 2021 Sep;22(5):759-766. doi: 10.1177/1129729820961955. Epub 2020 Oct 3.
Angioplasty-related vessel rupture is a common complication of interventions. The effect of covered stents to treat venous rupture has been evaluated in smaller series, but should be further evaluated.
To report the immediate outcomes and patency rates of a covered stent to rescue angioplasty-related venous rupture of hemodialysis vascular access.
From January 2013 to December 2018, 113 procedures complicated with vessel ruptures were retrospectively analyzed from a prospectively collected database of 8146 hemodialysis access interventions. The strategies to salvage vessel ruptures were based on the discretion of the treating physicians. Follow-up outcomes were obtained via review of the angiographic images, procedural notes, and medical and dialysis records within 12 months after the index procedures.
A total of 52 vessel ruptures (21 fistulas, 31 grafts) salvaged by using Viabahn covered stents were enrolled. Vessel ruptures developed in 28 (53.8%) thrombectomy procedures. Device success was achieved in all procedures (100%) and clinical success was achieved in 50 (96.2%). The primary patency of the stent area was 66.0% at 6 months and 50.0% at 12 months. The primary patency of the entire access circuit was 27.4% at 6 months and 16.0% at 12 months. The most common cause of access circuit primary patency loss was thrombotic occlusion for graft accesses and restenosis at stent area for native accesses. Eleven vascular accesses were abandoned within 12 months after vessel ruptures, and the secondary patency rate of the entire access circuit was 78.0% at 12 months.
Treatment of angioplasty-induced vessel rupture of hemodialysis vascular accesses by using Viabahn covered stents has good immediate outcomes and patency results at the stent area. Nonetheless, the patency rate of entire access circuit was still below the threshold recommended by guidelines.
血管成形术相关的血管破裂是介入治疗的常见并发症。已经有较小系列研究评估了带膜支架治疗静脉破裂的效果，但还需要进一步评估。
报告使用带膜支架治疗血液透析血管通路血管成形术后相关静脉破裂的即时结果和通畅率。
从 2013 年 1 月至 2018 年 12 月，我们从 8146 例血液透析通路介入治疗的前瞻性数据库中回顾性分析了 113 例并发血管破裂的手术。挽救血管破裂的策略基于治疗医生的判断。通过在索引手术后 12 个月内审查血管造影图像、手术记录和医疗及透析记录来获得随访结果。
共纳入 52 例（21 例瘘管，31 例移植物）采用 Viabahn 带膜支架治疗的血管破裂。血管破裂发生于 28 例（53.8%）血栓切除术过程中。所有手术均获得了器械成功（100%），临床成功 50 例（96.2%）。支架区域的主要通畅率在 6 个月时为 66.0%，12 个月时为 50.0%。整个通路的主要通畅率在 6 个月时为 27.4%，12 个月时为 16.0%。移植物通路主要通畅率丧失的最常见原因是血栓闭塞，而自体通路的主要通畅率丧失的原因是支架区域再狭窄。血管破裂后 12 个月内，有 11 条血管通路被废弃，整个通路的二级通畅率为 12 个月时为 78.0%。
使用 Viabahn 带膜支架治疗血液透析血管通路的血管成形术后血管破裂，支架区域即刻效果和通畅率良好。然而，整个通路的通畅率仍低于指南推荐的阈值。
