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
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