Zheng Xuan, Xi Weiwei, Shen Xiang, Li Hua, Huang Yibiao, Lu Mingxi
Department of Nephrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
J Vasc Access. 2025 Jul;26(4):1399-1407. doi: 10.1177/11297298241263369. Epub 2024 Aug 3.
To investigate the feasibility, methods and effects of interventional ultrasound in nitinol stent implantation to treat early restenosis after percutaneous transluminal angioplasty (PTA) in autogenous arteriovenous fistula (AVF).
From April 2018 to December 2021, 69 patients with early restenosis of AVF received ultrasound-guided nitinol stent implantation (UNSI) and were followed-up. Imaging features of the stent and procedure by ultrasound were observed. The technical success rate, clinical success rate and incidence of complications were recorded and counted. Target lesion primary patency (TLPP), access circuit primary patency (ACPP) and access circuit secondary patency (ACSP) were estimated.
Ultrasonography can show the structure of the stent and guide the stenting process clearly. Both the technical and clinical success rates were 100%. Thirty-one patients had in-stent restenosis (ISR), which was treated by plain balloon (PB) PTA or drug coated balloon (DCB) PTA. The TLPP at 3, 6, 12 and 24 months were 100.0%, 94.2%, 63.4% and 39.6%, respectively. The ACPP at 3, 6, 12 and 24 months were 98.6%, 91.6%, 60.2% and 35.2%, respectively. The ACSP at 3, 6, 12 and 24 months were 98.6%, 98.6%, 95.6% and 93.8%, respectively. The TLPP of ISR after DCB PTA at 3, 6 and 12 months were 100.0%, 100.0% and 93.6%, respectively.
This pilot study indicates ultrasonography can accurately guide nitinol stent implantation in AVF and this technique is a feasible and minimally invasive treatment for early restenosis after PTA with good short- and medium-term patency. DCB PTA may be used to deal with the ISR and is a way to prolong the patency of nitinol stent.
探讨介入超声在镍钛合金支架植入治疗自体动静脉内瘘（AVF）经皮腔内血管成形术（PTA）后早期再狭窄中的可行性、方法及效果。
2018年4月至2021年12月，69例AVF早期再狭窄患者接受超声引导下镍钛合金支架植入术（UNSI）并进行随访。观察支架的影像学特征及超声引导下的操作过程。记录并统计技术成功率、临床成功率及并发症发生率。评估靶病变原发通畅率（TLPP）、通路血管原发通畅率（ACPP）及通路血管继发通畅率（ACSP）。
超声可清晰显示支架结构并引导支架置入过程。技术成功率和临床成功率均为100%。31例患者发生支架内再狭窄（ISR），采用普通球囊（PB）PTA或药物涂层球囊（DCB）PTA治疗。3、6、12和24个月时的TLPP分别为100.0%、94.2%、63.4%和39.6%。3、6、12和24个月时的ACPP分别为98.6%、91.6%、60.2%和35.2%。3、6、12和24个月时的ACSP分别为98.6%、98.6%、95.6%和93.8%。DCB PTA治疗ISR后3、6和12个月时的TLPP分别为100.0%、100.0%和93.6%。
本前瞻性研究表明，超声可准确引导镍钛合金支架植入AVF，该技术是治疗PTA后早期再狭窄的一种可行且微创的治疗方法，具有良好的短期和中期通畅率。DCB PTA可用于处理ISR，是延长镍钛合金支架通畅率的一种方法。
