Franchin Marco, Coppola Andrea, Muscato Paola, Cervarolo Maria Cristina, Piffaretti Gabriele, Venturini Massimo, Tozzi Matteo
Vascular Surgery Unit, University of Insubria School of Medicine, Circolo University Teaching Hospital, Varese, Italy.
Diagnostic and Interventional Radiology Unit, University of Insubria School of Medicine, Circolo University Teaching Hospital, Varese, Italy.
J Vasc Access. 2024 Mar;25(2):407-414. doi: 10.1177/11297298221117948. Epub 2022 Aug 9.
Outflow vein stenosis is one of the commonest complications of both native and prosthetic vascular access. Together with angioplasty, first-line treatment is stenting. Although it has been described as a uncommon complication, the risk of stent migration should be always considered. We aimed to conduct a systematic review of literature concerning stents migration in vascular access, the possible outcomes and treatments. This study was performed applying Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were conducted in PubMed/Medline, Scopus, and Google scholar databases. Studies selection, data abstraction was done by two different reviewers. We identified 17 studies, comprising 18 cases (M:F 1:1, mean age 56 ± 18 (range 33-88)). All the patients underwent stenting for vascular access outflow stenosis. The commonest type of device reported was self expandible bare-metal stent. Intraoperative evidence of stent migration occurred in six cases at the final quality control, or for intraprocedure dyspnea onset. In two patients it was a incidental diagnosis. In the remaining cases, chest pain or dyspnea were the common delayed presentation symptoms. Even if stent migration is an uncommon event, it is burdened with low mortality and morbidity. Literature provide only few and frequently inadequate data. Stent removal is the treatment of choice when severe symptoms or cardiopulmonary complication are present. Endovascular procedures demonstrated to be an effective and safe alternative, while open surgical treatment is preferred whenever endovascular therapy failed or in selected cases.
流出静脉狭窄是自体和人工血管通路最常见的并发症之一。与血管成形术一起，一线治疗是支架置入术。尽管它被描述为一种罕见的并发症，但支架移位的风险应始终予以考虑。我们旨在对有关血管通路中支架移位、可能的结果及治疗的文献进行系统综述。本研究按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行。在PubMed/Medline、Scopus和谷歌学术数据库中进行检索。研究选择、数据提取由两名不同的评审员完成。我们确定了17项研究，包括18例患者（男:女为1:1，平均年龄56±18岁（范围33 - 88岁））。所有患者均因血管通路流出道狭窄接受了支架置入术。报告的最常见的器械类型是自膨式裸金属支架。在最终质量控制时，或因术中出现呼吸困难，6例患者有术中支架移位的证据。在2例患者中为偶然诊断。在其余病例中，胸痛或呼吸困难是常见的延迟出现症状。即使支架移位是一个罕见事件，但它的死亡率和发病率较低。文献仅提供了很少且常常不充分的数据。当出现严重症状或心肺并发症时，支架取出是首选治疗方法。血管内手术被证明是一种有效且安全的替代方法，而当血管内治疗失败或在某些特定病例中，开放手术治疗则更受青睐。
