Wang Y F, Liu W J, Zhang B H, Wang X F, Wang R M, Xue X L, Yue X H, Wang P, Liang X H
Blood Purification Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Department of Nephrology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Zhonghua Yi Xue Za Zhi. 2024 Aug 20;104(32):3025-3031. doi: 10.3760/cma.j.cn112137-20240202-00259.
To evaluate the prevalence, intervention methods and effect of arteriovenous graft (AVG) stenosis. The clinical data of patients who received AVG in the Blood Purification Center, the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2022 were retrospectively analyzed. The patency rate, prevalence and intervention effect of AVG stenosis were analyzed. A total of 475 patients aged (55.5±11.8) years were included, and there were 193 male cases (40.6%) and 282 female cases (59.4%). The patients were followed up for [ (, )] 19 (12, 30) months, and the primary, assisted primary and secondary patency were 14 (5, 27), 27 (13, 55), and 59 (33, 65) months, respectively. There were 799 access events which needed intervention, with a total standardized intervention rate of 0.90 per patient-year. Totally, 431(53.9%, 431/799) stenosis events occurred in 207 AVG. Among 422 AVG stenosis events with complete clinical data, 57.8% (244/422) were multi-site stenosis and 42.2% (178/422) were single-site stenosis. The most common sites of stenosis were graft-vein anastomosis (47.6%, 340/715), venous outflows (22.7%, 162/715), and puncture zone (20.0%, 143/715). In the 414 stenosis with intact follow-up data, 90.8% (376/414) were treated by balloon angioplasty, 8.5% (35/414) received covered stent insertion, and 0.7% (3/414) were intervened by open surgery. Clinical success rate was 98.1% (406/414). The primary patency time after endovascular treatment was 6 (4, 12) months. Covered stent significantly increased post-intervention primary patency time compared withballoon angioplasty [6 (3, 7) months vs 3 (1, 4) months, =0.020]. Stenosis is the most common complication of AVG, and the most common sites are graft-vein anastomosis, venous outflows, and puncture zone. Intervention of AVG stenosis has a high clinical success rate, and a relatively low post-intervention patency. Covered stent insertion improves the post-intervention patency of AVG, which has a poor effect using balloon expansion.
评估动静脉移植物（AVG）狭窄的发生率、干预方法及效果。回顾性分析2018年1月至2022年12月在郑州大学第一附属医院血液净化中心接受AVG的患者的临床资料。分析AVG狭窄的通畅率、发生率及干预效果。共纳入475例年龄为（55.5±11.8）岁的患者，其中男性193例（40.6%），女性282例（59.4%）。患者随访[（，）]19（12，30）个月，一期、辅助一期和二期通畅时间分别为14（5，27）、27（13，55）和59（33，65）个月。共发生799次需要干预的通路事件，患者年总标准化干预率为0.90。207例AVG中发生431例（53.9%，431/799）狭窄事件。在422例有完整临床资料的AVG狭窄事件中，57.8%（244/422）为多部位狭窄，42.2%（178/422）为单部位狭窄。最常见的狭窄部位是移植物-静脉吻合口（47.6%，340/715）、静脉流出道（22.7%，162/715）和穿刺区域（20.0%，143/715）。在414例有完整随访资料的狭窄中，90.8%（376/414）接受了球囊血管成形术治疗，8.5%（35/414）置入了覆膜支架，0.7%（3/414）接受了开放手术干预。临床成功率为98.1%（406/414）。血管内治疗后的一期通畅时间为6（4，12）个月。与球囊血管成形术相比，覆膜支架显著延长了干预后的一期通畅时间[6（3，7）个月对3（1，4）个月，=0.020]。狭窄是AVG最常见的并发症，最常见的部位是移植物-静脉吻合口、静脉流出道和穿刺区域。AVG狭窄的干预临床成功率高，但干预后的通畅率相对较低。置入覆膜支架可改善AVG干预后的通畅情况，球囊扩张效果较差。
