Endovascular Interventions for Peripheral and Central Venous Stenosis in Haemodialysis Patients with Arteriovenous Grafts

Full Article

KL Siu, FNY Sin, CY Fong, B Lo, LF Cheng, JKF Ma

Hong Kong J Radiol 2012;15:227-32

Purpose: To evaluate the efficacy of percutaneous balloon angioplasty for peripheral and central venous stenosis in haemodialysis patients with arteriovenous grafts.

Methods:Retrospective review of data from January 2006 to December 2010 was performed. Patients with arteriovenous grafts with single focal site (length <2.0 cm) venous stenosis who had initial successful balloon angioplasty were selected. Follow-up was performed at the attending renal centre with repeat angiograms as clinically required.

Results:Initial technical success rates were 96% and 84% for peripheral and central stenoses, respectively. Primary patency rates at 12 months for treated peripheral and central venous stenoses were 50% and 14%, respectively. The difference in primary patency rates in the two groups was statistically significant. The location of stenosis was the only dependent factor.

Conclusion: The results are comparable to those quoted by the National Kidney Foundation Dialysis Outcomes Quality Initiative guidelines. Percutaneous angioplasty at venous anastomosis and draining veins is a safe procedure, which prolongs patency. Due to the low primary patency rate of central stenosis, resorting to other methods such as the cutting balloon and stent-assisted angioplasty should be considered for such central lesions that recur.






方法:回顧2006年1月至2010年12月此類病人資料。入選病人為單發局灶性(長度少於2 cm)靜脈狹 窄,初次球囊血管成形術均成功。術後隨訪依據臨床要求,於腎病診療中心施以多次血管造影。

結果:外週和中心靜脈狹窄患者的初次手術成功率分別為96%及84%,術後12個月初級通暢率則分別 為50%及14%。兩組病人的初級通暢率有顯著統計學差異。狹窄部位是唯一决定因素。

結論:本研究結果與美國國家腎病基金會的透析預後質量倡議指南相一致。於靜脈吻合口和引流靜脈處行經皮血管成形術是維持血透通路開放的安全方法。由於中心靜脈狹窄初級通暢率偏低,狹窄 復發時可考慮採用切割球囊血管成形術及腔內支架植入術等其他方法。