Cutting balloon angioplasty in hemodialysis arteriovenous fistula stenosis resistant to conventional balloon angioplasty

Objective To investigate the efficacy and safety of cutting balloon angioplasty for the treatment of hemodialysis arteriovenous fistula stenosis resistant to conventional percutaneous transluminal angioplasty (PTA). Methods The patients with arteriovenous fistula stenosis who had suboptimal results (residual stenosis ＞30%) by conventional PTA from December 2011 to February 2015 were enrolled. All the patients received cutting balloon angioplasty were rechecked every three months. Results A total of 25 patients with age of (60.7±12.9) years had suboptimal PTA results. Eleven patients with native arteriovenous fistula (AVF) and 14 patients with graft fistula (AVG) underwent cutting PTA for 30 times. The technical success rate was 86.7% and clinical success rate was 100%. The diameter stenosis pre-procedural and post-procedural of cutting PTA was (1.7±0.6) mm and (4.5±0.8) mm respectively (P＜0.05). Six patients had multiple lesions and the stenosis consisted of 21 outflow venous, 6 graft-to-vein anastomosis, 6 cephalic arch, 2 artery and 1 puncture hole stenosis. The primary access patency at 3 and 6 months for AVF group were 70.0% and 10.0%, while for AVG group the figures were 64.3% and 7.1% (P＞0.05). The secondary access patency at 3 and 6 months for AVF group were 70.0% and 30.0%, while for AVG group the figures were 85.7% and 64.3% (P＞0.05). The follow-up time was (8.1±7.3) months. The restenosis rate was 64.0%. Cutting PTA failed to achieve technical success for four times, of whom 2 patients required graft stent implantation and 2 patients required ultra-high-pressure balloons angioplasty to finally achieve technical success. The median survival time of fistula was 173 days. Conclusions Cutting balloon angioplasty have well short-term patency and safety in arteriovenous fistula stenosis resistant to conventional PTA, especially for calcified lesion or "balloon waist". Although it could provide a satisfied long patency by recurrent PTA, the use of cutting balloon would be not advocated as the first-line treatment for fistula stenosis. The efficacy superiority of cutting balloon between AVF and AVG, as well as the cost-effect comparison between cutting balloon and high-pressure balloon, remains unclear, the verification of which requires large-sampled, prospective and randomized studies.     

Long-term outcomes and predictors of iliac angioplasty with selective stenting: is primary stenting necessary?

Percutaneous transluminal angioplasty (PTA) has become one of the initial treatment options in patients with iliac artery occlusive disease. Stents have been recommended to correct procedural complications and improve long-term patency. Many series advocate routine stent placement after an otherwise uncomplicated PTA (primary stenting) in an attempt to prevent recurrent disease. Currently, many physicians in the United States seem to use stents in the iliac artery more liberally, even on a routine basis. There is little evidence to support this practice, however. It is still unclear whether a stent should be inserted primarily or selectively. This article provides the data from an 11-year experience of angioplasty with selective stenting for iliac artery occlusive lesions and reviews the current literatures on the iliac artery stent placement.     

经皮腔内血管成形术治疗髂-股动脉狭窄或闭塞

目的探讨经皮腔内血管成形术（PTA）及血管内支架植入术治疗髂-股动脉狭窄或闭塞的应用价值。方法 66例髂-股动脉狭窄或闭塞患者,患肢均有不同程度的缺血症状,均采用PTA和（或）支架植入术进行介入治疗,分别于治疗前、后测定踝/肱指数（ABI）。结果 66例患者成功完成介入治疗,共植入支架73枚,其中髂动脉植入27枚,股浅动脉植入32枚,髂-股动脉植入14枚,无严重并发症发生。术后患者患肢缺血症状明显减轻或消失。ABI由术前0.39±0.12上升至0.72±0.15,术后随访3～24个月（平均15个月）,10例患者因复发而再次接受介入治疗。结论 PTA及血管内支架植入术,因其创伤小、可重复性高、疗效显著等特点已成为治疗髂-股动脉狭窄或闭塞的有效手段。     

Clinical application of covered metal stents in treating central venous occlusion of different branches in hemodialysis patients

Objective To evaluate the efficacy of covered stent (CS) in the treatment of central venous occlusive disease (CVOD) of different branches in hemodialysis patients. Methods Twenty-five cases of CVOD in the First Affiliated Hospital of Sun Yat-sen University from Oct 2015 to June 2018 were enrolled. All patients underwent percutaneous transluminal angioplasty (PTA)+stent graft (PTS) successfully. The stent grafts of different diameters were implanted according to intraoperative angiography to measure the diameter of normal blood vessels around the diseased vessels. The operation was successful and the follow-up data was complete. According to the different branches of central venous lesions, the patients were divided into three groups: subclavian vein group, brachiocephalic vein group and superior vena cava group. The stent diameter, primary patency and assisted primary patency time were analyzed and compared in the three groups. Results The diameters of the subclavian vein group, the brachiocephalic vein group, and the superior vena cava group were (10.29±0.42) mm, (12.29±0.32) mm and 13.00 mm, respectively. There were significant differences in the diameters of the subclavian vein group, the superior vena cava group and the brachiocephalic vein group (both P＜0.05). As of the end of follow-up, the primary patency time of the subclavian vein group, the brachiocephalic vein group, and the superior vena cava group was (10.57±2.00) months, (19.40±3.28) months, and (32.75±3.28) months respectively. The primary patency time of the superior vena cava group was significantly longer than the other two groups (P＜0.05). There was no significant difference in the primary patency time between the subclavian vein group and the brachiocephalic vein group (P=0.072). The assisted primary patency time of the subclavian vein group, the brachiocephalic vein group and the superior vena cava group was (15.57±3.20) months, (25.14±2.39) months, (39.00±3.03) months. There was a statistically significant difference in the assisted primary patency time between the three groups (P＜0.05). Conclusions There are differences in vascular patency between postoperative vascular grafts of different diameters in different sites. The larger the diameter of the lumen stent, the longer the stent patency time is. It is important to protect the blood vessels with smaller diameters.     

Comparison of clinical effects of bare stent and covered metal stent graft in the treatment of complete occlusion of central venography in hemodialysis patients

Objective To evaluate the efficacy of bare mental stent (BMS) and covered stent (CS) in the treatment of complete central venous occlusive disease (CVOD) in hemodialysis patients. Methods A total of 66 cases of CVOD who have been treated by endovascular methods successfully in the First Affiliated Hospital of Sun Yat-sen University from Jan 2015 to Jan 2017 were enrolled in this study. According to the type of stent，the patients were divided into two groups, BMS group (n=46) and CS group (n=20). The demographic data, clinical signs and symptoms, and pre-procedure and post-procedure imaging data were followed up and recorded. The primary patency rates were calculated at 1, 3, 6, 9, and 12 months. Results The related symptoms were improved within 2 day post-procedure. The primary patency rates of BMS group in 1, 3, 6, 9 and 12 months were 97.83%, 95.65%, 69.56%, 41.3%, and 34.78% respectively. The rates of CS group were 100%, 100%, 95%, 65%, and 60% respectively. They did not reached statistical significance for primary patency rates between two groups in 1, 3, and 6 months (P＞0.05 respectively). However, from 9 months after procedure, it began to show the significant difference between two groups (P＜0.05). The median patency time of the CS group was (10.30±5.32) months, while BMS group was (8.52±0.49) months. The difference between the two groups was statistically significant (P=0.046). Conclusions Stent implantation for complete occlusion of central venous in hemodialysis patients can get credible effect. The use of CS for CVOD provides superior patency as well as patency time in long period after procedure as compared with BMS.     

Traitement des sténoses et des oblitérations iliaques par angioplastie transluminale

PurposePercutaneous transluminal angioplasty (PTA) has an established and valuable role in the treatment of iliac stenoses and occlusions. The use of stents may improve the results of PTA. The aim of this study is to report our surgical experience of iliac angioplasty over the past 5 years.Patients and methodsFrom January 1993 to October 1997, 201 iliac PTA were performed in 175 patients, at the level of the common iliac artery (n = 111 ) and external iliac artery (n = 90). In 26 cases, two iliac lesions were treated simultaneously. There were 188 stenoses and 13 chronic occlusions. During PTA, 55 stents were used, because of unsatisfactory results (dissection, residual stenosis) or in case of total occlusion, in the common iliac artery in 35 cases and in the external iliac artery in 20 cases. In 15 cases (8.6%), a femoro-popliteal bypass was associated to the iliac PTA, because of multilevel occlusive disease.ResultsThere were no early deaths. There were seven initial failures. The initial success rate was 96%. The clinical follow-up has been achieved in 163 patients, (range: 3 to 48 months, mean: 28 months). The primary patency rates were 84%, 79% and 63% respectively at 1, 2, and 4 years. The secondary patency rates were 87%, 85% and 73% respectively at 1, 2, and 4 years.ConclusionPTA is a good procedure for aortoiliac disease. Selective use of stents may improve early results of PTA; however, routine use of stents cannot be recommended.     

Proximal venous outflow obstruction in patients with upper extremity arteriovenous dialysis access

To evaluate the impact of central venous obstruction on upper extremity hemodialysis access failure, we retrospectively analyzed our recent experience in managing this problem. We reviewed 158 upper extremity hemodialysis access procedures performed in 122 patients during a 1-year period. Fourteen (11.5%) patients had central vein obstruction as the cause of severe arm swelling, graft thrombosis, or graft malfunction. All 14 patients had had bilateral temporary subclavian vein dialysis catheters and failed upper extremity arteriovenous access. Seventeen lesions were treated in 14 patients including eight subclavian vein occlusions, six subclavian vein stenoses, two internal jugular vein stenoses, and one superior vena cava stenosis. Twenty-one procedures were performed including 17 percutaneous transluminal balloon angioplasties (PTAs) with stent placement in 13, two axillary to innominate vein bypasses, and two axillary to internal jugular vein bypasses. All patients had resolution of symptoms. Thirteen (76%) PTAs were initially successful but in four (24%) cases it was impossible to recanalize the vein. Eight (47%) PTAs provided functional hemodialysis access for 2 to 9 months, two (12%) restenosed at 3 and 10 months and were successfully redilated, two occluded at 2 and 4 months and were unable to be recanalized, and one failed immediately after a successful PTA. Four PTA failures were followed by venous bypass, which remained patent and provided functional access 7 to 13 months after surgery. Of nine stenotic venous lesions six (67%) were successfully dilated without restenosis, whereas of eight occluded veins only two (25%) were successfully treated without recurrence. Temporary central hemodialysis catheters produce a significant number of symptomatic central vein obstructions in patients with upper extremity arteriovenous access. PTA with stenting and venous bypass provides early success in most patients. Transcatheter therapy is less successful in treating complete venous occlusions when compared with stenotic lesions. All effort should focus on preventing this complication by avoiding the use of temporary subclavian vein hemodialysis catheters.     

Long-term outcome of angioplasty or stent placement for stenosis of the cavernous or petrous portion of the internal carotid artery

Percutaneous transluminal angioplasty (PTA) and stent placement are effective in patients with stenosis of the cavernous or petrous portion of the internal carotid artery (ICA), but the long-term outcomes remain unclear. The present study evaluated long-term outcomes in 54 patients treated by PTA or stent placement for stenotic lesions involving more than 50% of the cavernous or petrous portion of the ICA with ischemic symptoms or without ischemic symptoms if cerebral blood flow on single photon emission computed tomography images was decreased by 20% compared with the contralateral side. Follow-up magnetic resonance, three-dimensional computed tomography, and conventional angiography were performed. Patient condition in the follow-up period was investigated using telephone interviews or questionnaires. PTA was used to treat 13 lesions and stent placement for 41 lesions. Permanent and transient complications occurred in 2 and 5 patients, respectively. The morbidity rate was 13% (7 of 54 patients). The follow-up period ranged from 3 to 80 months (mean 29.9 months), and restenosis and occlusion were recognized in 4 patients (7.4%). Five patients died (2 of malignancy and 3 of myocardial infarction) during the follow-up period. PTA and stent placement are safe and effective in patients with stenosis of the cavernous or petrous portion of the ICA, and result in low long-term rates of restenosis.     

股动脉长段病变腔内治疗325例体会

目的探讨腔内治疗股动脉长段闭塞的技术问题。方法 2005年3月～2011年2月采用腔内介入治疗股动脉长段闭塞(闭塞长度均≥10.0cm)患者325例(381条肢体);将其治疗前后踝肱指数(ABI)进行比较,并对治疗后临床疗效及动脉通畅率进行统计分析。结果本组技术成功297例,技术成功率91.4%,15例(4.6%)单纯球扩,282例同时置入支架,术前、术后ABI比较,差异有统计学意义(0.31±0.10vs0.72±0.15,P<0.01)。出院时症状明显缓解者276例。随访206例,随访时间30天至50个月,症状复发55例,复发率26.7%,6例膝上截肢,5例膝下截肢,15例足趾截趾,保肢率88.9%;1、3年累积通畅率分别为62.3%、37.2%。结论腔内治疗股动脉长段闭塞微创、安全,近期疗效确切,注意介入技巧可以提高腔内治疗的成功率。     

经桡动脉行自体动静脉内瘘功能不良的介入治疗

目的探讨经桡动脉行自体动静脉瘘(AVF)腔内成形和(或)溶栓治疗的可行性。方法于因AVF狭窄或血栓闭塞而需行介入治疗的患者中,选取经桡动脉入路介入治疗的8例患者进行回顾性分析。结果首次造影证实6例患者为AVF重度狭窄,即刻行腔内球囊成形术,术后狭窄程度改善;对2例急性血栓形成患者行动脉内溶栓治疗,次日复查造影示血栓溶解,其中1例溶栓后造影显示吻合口附近静脉狭窄严重,行PTA治疗,另1例狭窄程度较轻者未进一步PTA治疗。对8例患者随访2~13个月,其中7例可正常行AVF透析,1例单纯PTA治疗患者2个月后再次行PTA治疗,4个月后因AVF功能不良而改行颈内静脉插管透析。结论经桡动脉行AVF功能不良的介入治疗有一定的可行性。     

Restoration of acutely thrombosed arterio-venous fistulae by rTPA and percutaneous angioplasty

Acute thrombosis in native arterio-venous fistulae (AVF) results in considerable patient morbidity. Interventional radiology (IR) comprising thrombolysis and percutaneous transluminal angioplasty (PTA) is well established in the management of thrombosed polytetrafluoroethylene (PTFE) grafts. However its role in thrombosed AVF is uncertain. We looked retrospectively at the role of IR in re-establishing blood flow in acutely throm-bosed AVF. Between 1992-2000, 21 episodes of acutely thrombosed AVF in 15 patients (9 females; age range 29-80yrs) were referred for intervention. All fistulae were being used for haemodialysis at the time. Diagnosis was established by angiography and thrombolysis with recombinant tissue plasminogen activator (rTPA) was attempted in all patients. Discrete stenoses when present (n=12) were then treated with PTA and resistant or recurrent stenoses were managed by stent insertion (n=3). Patients were then heparinised for 24 hours. Technical success as defined by radiological patency was achieved in 86% cases. Clinical success i.e. the ability to reuse of the fistula for haemodialysis was achieved in 62% of the interventions, where patency rates at 3 and 6 months were 92% and 69% respectively. Five patients had recurrence of thrombosis >3 months after the primary procedure, 3 had successful reintervention. Minor local bleeding was the only complication. Our retrospective study shows rTPA and PTA is successful in the management of acutely thrombosed AVF. We advocate the routine use of IR as a valuable technique for prolonging the life of native AVF in patients on maintenance haemodialysis.     

Treatment of "swing point stenoses" in hemodialysis arteriovenous fistulae

AIM: This is a retrospective study of percutaneous transluminal balloon angioplasty (PTA) efficacy for treatment of surgical vein mobilization site ("swing point") stenoses in hemodialysis arteriovenous fistulae (AVF) that fail to mature or are poorly functioning. METHOD: Between February 1, 1999, and February 28, 2001, 65 non-maturing or poorly functioning AVF were studied in 63 consecutive hemodialysis patients (30 male, 33 female, aged 26-92 years). All AVF underwent contrast angiography to study the inflow artery, AVF, outflow and central veins. PTA of stenotic sites was performed to initiate or restore AVF function. RESULTS: Seventy-eight venous and 2 arterial stenoses were found and treated with PTA in the 65 AVF. All PTA were technically successful. A total of 55 stenoses were identified in the vein at the site of surgical mobilization ("swing point"). Additionally, 19 cephalic and 4 central venous stenoses were found. During the study, 13 AVF underwent repeat PTA at the "swing point". Of the 65 AVF treated, 50 were being successfully used as an access site, 4 AVF were lost during follow-up (34-688 days; mean: 258 days) and 8 patients died within the study period. The duration of functional patency of the treated AVF was 39-660 days (mean: 280 days). CONCLUSION: Non-maturing or poorly functioning AVF frequently have stenoses in the outflow vein at the original site of surgical vein mobilization. These "swing point stenoses" are amenable to PTA, which is a safe and effective treatment for prolonging AVF patency and function.     

膝下血管微球囊扩张成形术在糖尿病足治疗中的应用

目的探讨膝下血管微球囊扩张成形术在糖尿病足治疗中的应用价值。方法选择我院2005年10月-2006年9月收治的以膝下动脉闭塞为主的糖尿病足患者33例，共44条肢体，均采用单纯球囊扩张成形术治疗膝下血管病变。结果44条肢体中技术成功40条（90．91％），临床成功42条（95．45％）。术后平均随访6个月（2～12个月），所有患者的肢体症状均未见加重或复发。结论膝下血管微球囊扩张成形术可以有效改善肢体远端血供，有效防止糖尿病足病发展，促进肢端创面愈合，提高患者生活质量，近期疗效显著，远期疗效尚待进一步观察。     

Value of stent placement during percutaneous transluminal angioplasty of the iliac arteries

BACKGROUND: To determine the benefits of stents during percutaneous transluminal angioplasty (PTA) of the iliac arteries. Retrospective analysis of our 10-year surgical experience with iliac PTA from 1988-1997 permitted comparison of results during two consecutive periods: an initial period (1988-1992), during which stents were never used, followed by a second period (1992-1997), when stenting was performed on indication. METHODS: From January 1988 to October 1997, 287 iliac PTA procedures (158 common iliac arteries, 129 external iliac arteries) were performed on 250 patients. Thirty-seven patients had two iliac lesions that were treated simultaneously. Indications for PTA included stenosis (270 cases) and chronic occlusion (17 cases). Thirty-one patients (12.4%) underwent infra-inguinal bypass in addition to PTA owing to the existence of arterial lesions at two levels. Two consecutive patient groups were defined: Group I consisted of 75 patients who underwent 86 iliac PTA procedures between January 1988 and May 1992 without stent placement; Group II consisted of 175 patients who underwent 201 iliac PTA procedures between June 1992 and October 1997, when selective stenting was performed. A total of 55 stents (35 in the common iliac artery, 20 in the external iliac artery) were placed in Group II during PTA due to unsatisfactory immediate results (dissection, residual stenosis) or occlusion. RESULTS: There was no 30-day mortality. There were 15 immediate failures of PTA: 8 in Group I (10.7%) and 7 in Group II (4%). The cumulative initial success rate was 94%. Follow-up ranged from 3 months to 102 months (mean 37 months). The cumulative primary patency rate at 4 years was 62% (58% in Group I, 64% in Group II). The cumulative secondary patency rate at 4 years (including patients who subsequently underwent repeat angioplasty procedures) was 72% (68% in Group I, 74% in Group II). CONCLUSIONS: Stents were an effective means for treatment of initial failures of PTA in patients with iliac artery occlusive disease. However, there were no significant differences in the long term results between PTA alone and PTA with selective stent placement.     

节段闭塞性布加综合征的腔内治疗

目的 探讨节段闭塞性布加综合征的腔内治疗经验.方法 回顾性分析45例节段闭塞性布加综合征的临床资料.分别采用下腔静脉开通术、经皮经腔血管成形术(percutaneoustransluminal angiophsty,PTA)及支架植入术治疗.复杂的病例采用三维数字减影血管造影(three-dimensional digital subtraction angiography,3D-DSA)技术进行多角度评估下腔静脉病变,寻找腔内治疗最佳工作角度.结果 本组45例中,43例成功穿通并扩张.下腔静脉压由术前的(35.3±3.9)cm H2O降至术后的(9.5±2.0)cm H2O,两者差异有统计学意义(t=43.68,P<0.01).2例下腔静脉穿通失败,改行腔房人工血管转流术.1例行PTA时发生急性心包填塞.35例获得随访,随访率77.8%(35/45),随访时间3～46个月,平均28.6个月.除1例术后15个月支架内血栓形成而改行腔房人工血管转流术外,其他34例患者无支架移位及肝静脉阻塞.心包填塞病例经手术修补下腔静脉后治愈,随访6个月除肋间神经痛外无其他不适.本组无肺栓塞及死亡病例.结论 节段闭塞性布加综合征腔内治疗的近期、中期疗效较好.3D-DSA技术有助于布加综合征的腔内治疗.     

Comparison of early clinical results of contact laser thermal angioplasty with a metal hot tip with balloon angioplasty

Contact laser thermal angioplasty with a metal hot tip heated by an Argon laser system (Trimedyne Inc.) was performed on 34 peripheral arterial occlusive or stenotic regions (7 iliac, 20 femoral and 7 popliteal arteries) in 22 patients with ASO. The early clinical results of laser angioplasty were investigated by comparing those of 15 patients treated by percutaneous transluminal balloon angioplasty (PTA). There was no perforation of the arterial wall caused by thermal ablation with the hot tip heated by repeated pulses under power conditions of 10 watts of laser energy for 5 seconds. Detachment of the hot tip caused by frequent healing without a sufficient period of tip cooling was observed in 2 cases. Acute thrombosis was observed in 1 patient during reconstruction of the proximal artery. The initial success rate of laser angioplasty and PTA was 91.2% and 86.7%, respectively. Re-stenosis or occlusion was observed in 7 of 31 regions 6 months after laser angioplasty. Satisfactory results were not obtained in the femoral artery. The overall patency rate of laser angioplasty and PTA was 77.4% and 69.2%, respectively. The initial success rate of laser angioplasty in totally obstructed arterial regions was higher than that of PTA.     

Central vein obstruction in hemodialysis patients: results of radiological and surgical intervention.

BACKGROUND/AIMS: Symptomatic central venosus obstruction (CVO) in dialysis patients with arteriovenous fistulas (AVFs) leads to significant morbidity and patient inconvenience. We evaluated the results of surgical and radiological interventional treatment of symptomatic central venous obstruction. METHODS: Clinical data, site and length of vein obstruction, type and outcome of intervention were obtained from patient records. Patency rates of radiological and surgical treatment were calculated using Life Table survival analysis. RESULTS: In 28 patients with VH, 45 interventions (percutaneous intervention 30; surgical reconstruction 10; AVF closure five) were performed. Mean vessel obstruction length was 4.9 cm, mainly localized in the subclavian vein (55%). Initial clinical success rate of PTA and surgery was 92%, with complications after percutaneous transluminal angioplasty (PTA) on six occasions. Restenosis after PTA was observed in 39%. One-year primary and secondary patency after PTA was 50 and 63%, respectively. One-year primary patency after surgical reconstruction was 75%. CONCLUSION: Symptomatic CVO in dialysis patients with AVFs can be treated with a high success rate through radiological intervention. Surgical reconstruction is an appropriate alternative method in case of failed PTA.     

Ultrasound evaluation and interventional therapy for peripheral vascular access stenosis in dialysis patients

Objective To investigate the patency rate and restenosis after percutaneous transluminal angioplasty (PTA) for the treatment of arteriovenous fistula (AVF) and arteriovenous graft (AVG) stenosis in dialysis patients. Methods The patients who were successfully treated by PTA for the first time in the blood purification center of the 2nd Affiliated Hospital of Nanjing Medical University from January 2016 to June 2017, including 71 cases of AVF in the forearm, 52 cases of AVF in the upper arm and 59 cases of AVG were recorded. The data of different stenosis parts were analyzed before and after treatment and followed up for 12 months. The initial patency rate and assisted-PTA patency rate were observed at 3 months, 6 months, 9 months, and 12 months after ultrasound interventional therapy, and the initial patency time for patients who needed to reintervention among all types of pathways were recorded. Results The initial patency rates at 3 months, 6 months, 9 months and 12 months after ultrasound interventional therapy were 98.59%, 90.14%, 71.93%, 54.93% respectively in forearm AVF, 90.38%, 65.38%, 42.31%, 32.69% respectively in upper arm AVF, 91.53%, 32.20%, 6.78%, 1.69% respectively in AVG, and the PTA-assisted patency rates were 98.59%, 97.18%, 95.77%, 94.37% respectively in forearm AVF, 92.31%, 86.54%, 84.62%, 80.77% respectively in upper arm AVF, 100.00%, 98.31%, 96.61%, 93.22% respectively in AVG, while the initial patency time was (8.99±3.54) months in forearm AVF, (6.33±3.01) months in upper arm AVF, (4.80±1.40) months in AVG respectively. Conclusions Ultrasound can comprehensively evaluate the function of peripheral vascular access, guide PTA treatment, and evaluate treatment outcomes. Ultrasound intervention therapy has best initial patency rate for forearm AVF stenosis. The prognosis of upper arm AVF stenosis PTA is relatively poor due to the easy cephalic stenosis. Although AVG has a short interval of restenosis, it can achieve a better long-term patency rate through regular intervention with ultrasound intervention.     

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??Simple percutaneous transluminal angioplasty versus primary stent placement in treating short-intermediate superficial femoral-popliteal artery occlusive disease about clinical safety and efficacy??A Meta-analysis SI Xiao-mao*?? ZHA Bin-shan?? XIE Wen-tao??et al. *Department of Vascular Surgery, the First Affiliated Hospital of Anhui Medical University??Hefei 230032, China
Corresponding author: ZHU Hua-gang, E-mail??huagzhu@yeah.net
Abstract Objective To compare the clinical safety and efficacy of primary stent placement (ST) versus simple percutaneous transluminal angioplasty (PTA) in treating superficial femoral-popliteal artery (SFPA) occlusive disease using Meta-analysis method. Methods Prospective randomized controlled trials (RCT??comparing ST and PTA clinical effects published from January 1993 to January 2013 were retrieved. A Meta-analysis was conducted to estimate the immediate operation success rate, postoperative restenosis rate, target vessel revascularization (TVR). Results A total of 9 RCT were included in the analysis, including 948 patients and 971 limbs??489 limbs in ST group and 482 limbs in PTA group. The immediate operation success rate was higher in the ST group and the difference was significant statistically (OR=7.02, 95% CI 3.83-12.86, P<0.001). Postoperative 12 months vascular restenosis rates in ST group were less than those in PTA group with significant difference??OR=0.58??95%CI 0.38-0.89??P=0.01??. The difference of postoperative 24 months vascular restenosis rates between two groups was not significant statistically??OR=0.82??95%CI 0.55-1.24??P=0.35??. There was no difference statistically in target vessel revascularization and vascular complications between two groups (P>0.05). Conclusion For short-intermediate SFPA occlusion lesions (less than 15cm), short-term outcomes of ST is better than the PTA. But there is not enough evidence to prove that long-term outcome (longer than 24 months) of ST group is better than the PTA group.     

Application of percutaneous transluminal balloon dilatation in patients with catheter-related central vein disease

Objective To investigate the application of percutaneous transluminal balloon dilatation (PTA) in catheter replacement within patients with catheter-related central vein disease (CVD). Methods Thirteen cases of CVD patients from Jan 2015 to Mar 2018 admitted into the First Affiliated Hospital of Zhejiang University were retrospectively analyzed. All of them underwent digital subtraction angiography (DSA) to clarify problem origin. Suitable balloons were chosen to dilate the original catheters or the occlusive veins, and then the original catheters were replaced. PTA was used to help catheter replacement and all patients were followed up for 6 months. Results Four of the 13 patients were found stuck when replacing catheters. All of them successfully had catheters removed with PTA (Hong's techniques). All patients had successfully catheter replacement with blood flow volume＞250 ml/min. Among 4 patients with edema, 3 patients showed better within 6 months. Only 3 patients needed warfarin to keep blood flow volume＞250 ml/min within 6 months. Conclusions PTA shows advantages of lesser trauma, better tolerance and higher success rate in patients with catheter-related CVD. It can also relieve symptoms resulting from occlusive central vein.