Hashimoto Shun, Numasawa Yohei, Tamura Tadafumi, Kamata Kei, Shinoda Yuhei, Ono Shoya, Yokokura Souichi, Kojima Hidenori, Tanaka Makoto
Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan.
J Cardiol Cases. 2024 Oct 11;30(6):205-209. doi: 10.1016/j.jccase.2024.09.005. eCollection 2024 Dec.
Data about the long-term safety and efficacy of stent implantation for central venous stenosis in patients on dialysis are limited. We report the case of a 66-year-old man on hemodialysis for end-stage renal disease who presented with stasis dermatitis around an arteriovenous shunt with ulceration of the left forearm. Computed tomography angiography showed a tight stenosis of the proximal left subclavian vein and the development of collateral blood vessels around the stenosis. Percutaneous transluminal angioplasty (PTA) was performed and a bare nitinol stent was implanted in this lesion with intravascular ultrasound (IVUS) guidance. After PTA, the stasis dermatitis improved and the left arm circumference decreased significantly. No stent-related adverse events, such as stent occlusion, left arm swelling, and shunt failure, had occurred by 10 years after PTA. Generally, the patency rate after stenting for central vein stenosis is considered unfavorable. However, in this case, long-term patency might have been achieved by precise assessment of the vessel diameter using IVUS, implantation of a self-expandable stent of the appropriate size, and initiation of post-stenting antithrombotic therapy. This is the first report that highlights the long-term safety and efficacy of IVUS-guided stent implantation in a patient with shunt failure.
We report a 66-year-old man on hemodialysis with ulcerating stasis dermatitis around an arteriovenous shunt due to subclavian vein stenosis. We implanted an appropriately sized self-expandable stent using intravascular ultrasound. The patient's clinical course has been uneventful in the past 10 years. This case demonstrates the long-term efficacy of intravascular ultrasound-guided stent implantation for central venous stenosis in a patient with shunt failure.
关于透析患者中心静脉狭窄支架植入术的长期安全性和有效性的数据有限。我们报告了一例66岁的终末期肾病血液透析患者，其左前臂动静脉分流处出现淤积性皮炎并伴有溃疡。计算机断层血管造影显示左锁骨下静脉近端严重狭窄，狭窄周围出现侧支血管。进行了经皮腔内血管成形术（PTA），并在血管内超声（IVUS）引导下将裸镍钛合金支架植入该病变处。PTA后，淤积性皮炎有所改善，左臂周长显著减小。PTA后10年未发生任何与支架相关的不良事件，如支架闭塞、左臂肿胀和分流失败。一般来说，中心静脉狭窄支架置入后的通畅率被认为不理想。然而，在本病例中，通过使用IVUS精确评估血管直径、植入合适尺寸的自膨式支架以及启动支架置入后的抗血栓治疗，可能实现了长期通畅。这是首例强调IVUS引导下支架植入术在分流失败患者中的长期安全性和有效性的报告。
我们报告了一名66岁的血液透析患者，因锁骨下静脉狭窄，动静脉分流周围出现溃疡性淤积性皮炎。我们使用血管内超声植入了合适尺寸的自膨式支架。在过去10年中，患者的临床过程平稳。本病例证明了血管内超声引导下支架植入术对分流失败患者中心静脉狭窄的长期疗效。
