Percutaneous Transanastomotic Stent Graft Deployment to Salvage Dysfunctional Native Forearm Radiocephalic Fistulae: Feasibility and Primary Patency at 12 Months
Autor: | Giovanni Leati, Lorenzo Paolo Moramarco, Franco Galli, Carmine Tinelli, Nicola Cionfoli, Riccardo Corti, Pietro Quaretti, Ilaria Fiorina |
---|---|
Rok vydání: | 2018 |
Předmět: |
Male
Time Factors Percutaneous medicine.medical_treatment Kaplan-Meier Estimate 030204 cardiovascular system & hematology Clinical success 030218 nuclear medicine & medical imaging 0302 clinical medicine Risk Factors Major complication Polytetrafluoroethylene Aged 80 and over Graft Occlusion Vascular Thrombolysis Middle Aged Forearm Treatment Outcome medicine.anatomical_structure Radial Artery Female Stents Cardiology and Cardiovascular Medicine Adult medicine.medical_specialty Collateral Circulation Surgical Revision Prosthesis Design Veins Blood Vessel Prosthesis Implantation 03 medical and health sciences Arteriovenous Shunt Surgical Renal Dialysis Angioplasty medicine Humans Radiology Nuclear Medicine and imaging Vascular Patency Aged Proportional Hazards Models Retrospective Studies Chi-Square Distribution business.industry Stent Phlebography Blood Vessel Prosthesis Surgery Multivariate Analysis Feasibility Studies business |
Zdroj: | Journal of Vascular and Interventional Radiology. 29:986-992 |
ISSN: | 1051-0443 |
Popis: | Purpose To evaluate feasibility and efficacy of transanastomotic self-expandable polytetrafluoroethylene stent graft placement for salvage of radiocephalic arteriovenous fistulae (RCAVFs). Materials and Methods From 2008 to 2016, 26 patients (21 male; age, 38–80 y) with dysfunctional RCAVFs for juxtaanastomotic lesions that were unresponsive to angioplasty underwent transanastomotic stent graft placement. Stenotic and thrombotic lesions were included. All were deemed unsuitable for surgical revision. Patency rates were calculated per Kaplan–Meier method. A Cox analysis was used to identify influencing factors. Results Thirty-two stent grafts (6 patients had 2 stents) were deployed. Anatomic and clinical success were achieved in all patients; no major complications occurred. Mechanical and/or pharmacologic thrombolysis was performed in 6 cases before stent graft deployment. During follow-up (median, 34.7 mo; range, 1.9–102.7 mo), 17 repeat interventions were required in 10 patients (43 procedures overall), for an endovascular intervention rate of 0.27 per year. At 3, 6, 12, and 24 months, primary patency (PP) rates were 96% ± 4 (95% CI, 75%–99%), 83% ± 7 (95% CI, 61%–93%), 78% ± 8 (95% CI, 55%–90%), and 69% ± 10 (95% CI, 46%–84%). The corresponding assisted PP rates were 96% ± 4 (95% CI, 76%–99%), 96% ± 4 (95% CI, 76%–99%), 92% ± 5 (95% CI, 71%–98%), and 82% ± 8 (95% CI, 60%–93%). Five AVFs were ultimately abandoned. Per Cox analysis, arterial diameter ≥ 4 mm was associated with better PP ( P = .032). Conclusions Transanastomotic stent graft placement for RCAVF salvage is feasible and safe, providing patency rates comparable with historical endovascular and surgical data. Its role should be evaluated in larger studies. |
Databáze: | OpenAIRE |
Externí odkaz: |