Cline Brendan C, Zuchowski Adam, Gage Shawn M, Martin Jonathan G, Ronald James, Southerland Kevin W, Lawson Jeffrey H, Dillavou Ellen D, Kim Charles Y
Division of Interventional Radiology, Duke University Medical Center, Durham, NC, USA.
Humacyte Incorporated, Durham, NC, USA.
J Vasc Access. 2021 Dec 10;24(5):989 - 993. doi: 10.1177/11297298211048061. Print 2023 Sep.
The purpose of this study was to assess the feasibility and outcomes of recanalization and subsequent HeRO graft outflow component insertion across stent interstices in patients with an otherwise abandoned upper extremity.
Over a 10-year period, 15 patients underwent central venous recanalization by interventional radiology across the interstices of one or more occluded stents for the purpose of subsequent HeRO graft creation. A tunneled central venous catheter was left across the stent and occlusions with tip in right atrium. On a later date, the catheter was used for rapid guidewire access for HeRO graft implantation in the OR by vascular surgery. Procedural and clinical outcomes were determined by retrospective review. Primary and secondary HeRO graft patency rates were estimated with the Kaplan-Meier technique.
The technical success rates of recanalization across stent interstices was 100% (15/15). Between one and four overlapping stent walls were traversed. The technical success of the patients who underwent attempted HeRO graft implantation with outflow component traversing across stent interstices was 91% (11/12). No major complications were encountered with either recanalization or HeRO graft implantation. The primary and secondary HeRO patency rates at 12 months were 64% and 80%, respectively.
HeRO graft insertion across stent interstices is feasible and can provide effective permanent AV access; thus, the presence of stents across the subclavian and brachiocephalic veins should not be considered a contraindication.
本研究的目的是评估在原本已放弃的上肢患者中，经支架间隙进行再通并随后植入HeRO移植物流出道组件的可行性和结果。
在10年期间，15例患者接受了介入放射学引导的中心静脉再通术，通过一个或多个闭塞支架的间隙，以便随后创建HeRO移植物。一根隧道式中心静脉导管穿过支架留置，导管尖端位于右心房。在随后的日期，该导管用于在手术室中通过血管外科手术进行HeRO移植物植入时的快速导丝通路建立。通过回顾性分析确定手术和临床结果。采用Kaplan-Meier技术估计HeRO移植物的初级和次级通畅率。
经支架间隙再通的技术成功率为100%（15/15）。穿过了1至4个重叠的支架壁。尝试通过支架间隙植入HeRO移植物流出道组件的患者的技术成功率为91%（11/12）。再通或HeRO移植物植入均未出现重大并发症。HeRO移植物在12个月时的初级和次级通畅率分别为64%和80%。
经支架间隙植入HeRO移植物是可行的，并且可以提供有效的永久性动静脉通路；因此，锁骨下静脉和头臂静脉处存在支架不应被视为禁忌证。
