Liang Huei-Lung, Chen Matt Chiung-Yu, Su I-Li, Chiang Chia-Ling, Chen Chien-Liang
Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Interventional Center, Antai Tian-Sheng Memorial Hospital, Pingtun, Taiwan.
J Vasc Access. 2025 Sep 5:11297298251364334. doi: 10.1177/11297298251364334.
Although stent grafts have demonstrated significant benefits over bare metal stents and conventional venoplasty at maintaining patency of dialysis vascular access, they are far from perfect and are prone to edge stenosis. A new strategy of placing stent graft to reduce the possible occurrence of edge stenosis is therefore proposed in this study.
A retrospective review between 2015 and 2023 identified 21 arteriovenous grafts (AVG) hemodialysis patients who underwent stent graft placement with the medial stent end in an outflow venous valve. The indications for stent graft placement were either due to frequent recoil venous anastomotic stenoses recalcitrant to venoplasty or vascular ruptures after balloon dilation. Stent grafts of 6-7 mm in diameter were deployed crossing the venous anastomosis onto a venous valve. The primary stent-end patency, primary and secondary access patency were calculated with Kaplan-Meier analysis.
Technical success was achieved in 100% of the 21 patients. The median primary stent-end patency was 24 months with the patency rates at 12- and 24-month of 65.3% and 43.5% respectively. Six patients had in-stent stenosis and three patients had stent graft downward migration, resulting in edge stenosis. The secondary access patency rates at 1- and 2-year were 100% and 94.7%, respectively. No major complications were encountered in this study.
Placing the stent graft end in an outflow venous valve seems to reduce occurrence of the edge stenosis, and therefore prolong the stent graft patency.
尽管覆膜支架在维持透析血管通路通畅方面已显示出比裸金属支架和传统静脉成形术具有显著优势，但它们远非完美，且容易出现边缘狭窄。因此，本研究提出了一种放置覆膜支架以减少边缘狭窄可能发生的新策略。
对2015年至2023年间的回顾性研究确定了21例接受动静脉内瘘（AVG）血液透析的患者，这些患者在内侧支架末端位于流出静脉瓣膜处接受了覆膜支架置入术。覆膜支架置入的指征是频繁出现对静脉成形术顽固的静脉吻合口回缩狭窄或球囊扩张后血管破裂。将直径为6 - 7毫米的覆膜支架穿过静脉吻合口放置在静脉瓣膜上。采用Kaplan-Meier分析计算主要支架末端通畅率、主要和次要通路通畅率。
21例患者全部获得技术成功。主要支架末端通畅的中位时间为24个月，12个月和24个月时的通畅率分别为65.3%和43.5%。6例患者出现支架内狭窄，3例患者出现覆膜支架向下移位，导致边缘狭窄。1年和2年时的次要通路通畅率分别为100%和94.7%。本研究未遇到重大并发症。
将覆膜支架末端放置在流出静脉瓣膜处似乎可减少边缘狭窄的发生，从而延长覆膜支架的通畅时间。
