Department of Vascular surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China.
J Vasc Access. 2024 May;25(3):813-820. doi: 10.1177/11297298221134142. Epub 2022 Nov 2.
To evaluate the effectiveness of stent graft (SG) for the treatment of central venous disease (CVD) in hemodialysis patients.
Between January 2014 and April 2022, 122 patients on hemodialysis with symptomatic CVD were treated with percutaneous transluminal angioplasty (PTA) and bare-metal stent (BMS) or SG placement. The mean follow-up was 14.5 months (IQR: 8.0, 24.2). Patency rates of the target sites were calculated using Kaplan-Meier and log-rank studies. Multivariate Cox proportional hazard models were used to evaluate the association between various characteristics and target site primary patency.
Technical success rate was 100%. At 3, 6, 12, and 24 months, the target sites primary patency rates were 86.4%, 74.2%, 45.1%, and 30.4% for PTA; 94.7%, 78.6%, 60.8%, and 45.6% for BMS; and 94.0%, 92.0%, 82.4%, and 66.8% for SG, respectively, and the assisted primary patency rates were 86.5%, 80.4%, 63.8%, and 46.0% for PTA; 94.7%, 89.5%, 77.5%, and 71.1% for BMS; 100%, 100%, 97.8%, and 83.4% for SG, respectively. The Kaplan-Meier analysis indicated that SGs achieved better primary and assisted primary patency than PTA or BMS (<0.05). SG use and concomitant stenosis were the independent predictors of target site primary patency dysfunction in the multivariate analysis.
This study confirmed the better long-term patency of SG in comparison with PTA and BMS for the treatment of CVD in hemodialysis patients.
评估支架移植物（SG）治疗血液透析患者中心静脉疾病（CVD）的效果。
2014 年 1 月至 2022 年 4 月，对 122 例血液透析伴症状性 CVD 的患者进行经皮腔内血管成形术（PTA）和裸金属支架（BMS）或 SG 置放治疗。平均随访时间为 14.5 个月（IQR：8.0，24.2）。采用 Kaplan-Meier 和对数秩检验计算目标部位的通畅率。多变量 Cox 比例风险模型用于评估各种特征与目标部位初次通畅率之间的关系。
技术成功率为 100%。在 3、6、12 和 24 个月时，PTA 的目标部位初次通畅率分别为 86.4%、74.2%、45.1%和 30.4%；BMS 分别为 94.7%、78.6%、60.8%和 45.6%；SG 分别为 94.0%、92.0%、82.4%和 66.8%，辅助初次通畅率分别为 86.5%、80.4%、63.8%和 46.0%；BMS 分别为 94.7%、89.5%、77.5%和 71.1%；SG 分别为 100%、100%、97.8%和 83.4%。Kaplan-Meier 分析表明，SG 的初次和辅助初次通畅率优于 PTA 或 BMS（<0.05）。多变量分析显示，SG 的使用和并存狭窄是目标部位初次通畅率障碍的独立预测因素。
本研究证实，与 PTA 和 BMS 相比，SG 治疗血液透析患者 CVD 的长期通畅率更好。
