Zhao Yuliang, Liu Caihong, Wei Wei, Cui Tianlei
Division of Nephrology, Institute of Kidney Diseases, West China Hospital of Sichuan University, Chengdu, China.
National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China.
J Endovasc Ther. 2024 Sep 28:15266028241283661. doi: 10.1177/15266028241283661.
This study aimed to evaluate the efficacy and safety of stent placement after percutaneous recanalization of superior vena cava (SVC) stenosis in maintenance hemodialysis patients.
Adult maintenance hemodialysis patients hospitalized at a university-affiliated tertiary hospital due to SVC stenosis from January 2016 to June 2023 were prospectively included. The efficacy and safety of percutaneous blunt/sharp SVC recanalization combined with SVC stent placement were observed. The patients' demographic information and laboratory examination data, stent placement success rate, surgery-related complications, and long-term vascular access patency rate were also recorded and analyzed. The study was approved by the institutional ethics committee (2015-201) and registered at http://www.chictr.org.cn (registry number: ChiCTR-ONN-16007790).
A total of 58 patients were included in the study with an average age of 54.79±13.42 years. Percutaneous SVC recanalization was successful in 53 cases, with a success rate of 91.38%, including 37 cases of traditional recanalization and 16 cases of sharp recanalization. Among 53 hemodialysis patients who underwent SVC recanalization, 14 patients successfully received covered stents and 38 patients received bare metal stents, achieving a stent placement success rate of 98.1%. One patient encountered stent displacement into the heart immediately after implantation, causing intra-operative cardiac tamponade, who was successfully rescued by thoracotomy. Fifty-two patients were followed-up for median period of 26 months (cuffed catheter: 25 patients, arteriovenous fistula [AVF]: 27 patients). The overall 2-year vascular access patency rate was 33.2% (cuffed catheter: 22.2%, AVF: 41.7%, p=0.414). There was no statistically significant difference in the 2-year vascular access patency rate between the traditional recanalization group and the sharp recanalization group (34.1% vs 31.1%, p=0.731) and between bare metal stent group and covered stent group (38.1% vs 21.4%, p=0.248).
Percutaneous SVC recanalization with stent placement is an effective treatment strategy that can provide viable vascular access for maintenance hemodialysis patients with SVC stenosis. Cautions should be paid to potential life-threatening complications such as stent displacement and cardiac tamponade.
Superior vena cava (SVC) stenosis is a common central venous occlusive lesion in maintenance hemodialysis patients. Whether stent should be implanted simultaneously following SVC recanalization is still lacking research. This pilot cohort study suggested that percutaneous SVC recanalization with stent placement was an effective treatment strategy which provides satisfactory vascular access for hemodialysis. We further found that SVC sharp recanalization with subsequent stent implantation was a feasible treatment, with the 2-year vascular access patency comparable to the traditional SVC recanalization group. This study also highlighted endovascular SVC recanalization should be performed with caution, and appropriate balloon sizes should be selected to avoid SVC rupture or stent displacement.
本研究旨在评估维持性血液透析患者经皮上腔静脉（SVC）狭窄再通术后支架置入的疗效和安全性。
前瞻性纳入2016年1月至2023年6月因SVC狭窄在一所大学附属三级医院住院的成年维持性血液透析患者。观察经皮钝性/锐性SVC再通联合SVC支架置入的疗效和安全性。记录并分析患者的人口统计学信息和实验室检查数据、支架置入成功率、手术相关并发症以及长期血管通路通畅率。本研究经机构伦理委员会批准（2015 - 201），并在http://www.chictr.org.cn注册（注册号：ChiCTR - ONN - 16007790）。
本研究共纳入58例患者，平均年龄54.79±13.42岁。经皮SVC再通成功达53例，成功率为91.38%，其中传统再通37例，锐性再通16例。在53例行SVC再通的血液透析患者中，14例成功置入覆膜支架，38例置入裸金属支架，支架置入成功率为98.1%。1例患者植入后支架立即移位至心脏，导致术中心脏压塞，经开胸手术成功抢救。52例患者接受随访，中位随访时间为26个月（带 cuff 导管：25例患者，动静脉内瘘[AVF]：27例患者）。总体2年血管通路通畅率为33.2%（带 cuff 导管：22.2%，AVF：41.7%，p = 0.414）。传统再通组与锐性再通组2年血管通路通畅率差异无统计学意义（34.1%对31.1%，p = 0.731），裸金属支架组与覆膜支架组差异亦无统计学意义（38.1%对21.4%，p = 0.248）。
经皮SVC再通并置入支架是一种有效的治疗策略，可为SVC狭窄的维持性血液透析患者提供可行的血管通路。应注意潜在的危及生命的并发症，如支架移位和心脏压塞。
上腔静脉（SVC）狭窄是维持性血液透析患者常见的中心静脉闭塞性病变。SVC再通后是否应同时植入支架仍缺乏研究。这项前瞻性队列研究表明，经皮SVC再通并置入支架是一种有效的治疗策略，可为血液透析提供满意的血管通路。我们进一步发现，SVC锐性再通并随后植入支架是一种可行的治疗方法，其2年血管通路通畅率与传统SVC再通组相当。本研究还强调，血管内SVC再通应谨慎进行，应选择合适的球囊尺寸以避免SVC破裂或支架移位。
