Endovascular stent implantation for the management of postoperative right ventricular outflow tract obstruction: clinical efficacy.

OBJECTIVE: Extracardiac conduits between the right ventricle and pulmonary arteries commit patients to multiple reoperations. We reviewed our experience with stent implantation in obstructed conduits. METHODS: Between 1990 and 1997, stents were implanted across 43 conduits. The median age at procedure was 6 years (0.5-17 years), and the median interval between conduit insertion and stent implantation was 2.4 years (0.3-14 years). RESULTS: Mean systolic right ventricular pressures and gradients, respectively, decreased from 71 +/- 18 mm Hg and 48 +/- 19 mm Hg before to 48 +/- 15 mm Hg and 19 +/- 13 mm Hg after stent placement. Mean percentage of predicted valve area for body surface area increased from 26% +/- 12% to 48% +/- 17% after stent placement. Fifteen patients underwent a second transcatheter intervention (dilation or additional stent), and 2 patients, a third, allowing further postponement of surgery in 8 patients. One sudden death occurred 2.8 years after stent placement. Surgical conduit replacement has occurred in 20 patients. Body growth was maintained during follow-up. Freedom from surgical reintervention was 86% at 1 year, 72% at 2 years, and 47% at 4 years. Higher right ventricular pressure and gradient before and after stent placement and lower percentage of predicted valve area for body surface area after stent placement were associated with shorter palliation. CONCLUSION: Endovascular stent placement across obstructed conduits is a safe and effective palliation that allows for normal body growth.     

Salvage of thrombosed dialysis access grafts with venous anastomosis stents

BACKGROUND: Thrombosis of arteriovenous (AV) grafts caused by stenosis at the venous anastomosis is a well-described problem. Surgical thrombectomy and conventional angioplasty with mechanical thrombectomy have provided good success rates in achieving immediate graft patency but with generally dismal graft survival rates in the range of 11% to 36% at 6 months' follow-up. The role of intravascular stents in patients who have failed angioplasty or surgical revision at the venous anastomosis has not been fully elucidated, particularly in older grafts that have previously undergone multiple procedures. METHODS: In this series, 34 patients had self-expanding nitinol stents placed at the venous anastomosis following graft thrombectomy and angioplasty procedures. Patients were selected for stent placement if conventional angioplasty alone was unsuccessful due to immediate elastic recoil or residual stenosis. All patients were followed after stent placement and evaluated for duration of graft patency and need for repeated endovascular procedures. RESULTS: The average graft age at the time of stent placement was 17.9 months. Eight-eight percent of grafts were functioning at 6 months' follow-up, and 63% of the entire group had survived without the need for additional procedures. Among those with need for repeat interventions, 81% had new lesions outside of the stent, and 57% had new lesions within the stent. In 38% of cases, new stenoses were located both outside and within the stent. Among grafts no longer being used, only 19% of the time was it due to disease recurring within the stent. CONCLUSION: Polytetrafluoroethylene (PTFE) graft longevity is improved when venous anastomosis stenoses are treated with stents in selected cases of older grafts that would have normally undergone abandonment or surgical revision.     

Long-Term Outcome of Portal Vein Stenting After Pediatric Living Donor Liver Transplantation

BackgroundPortal vein (PV) stenosis is sometimes seen in pediatric living donor liver transplantation (LDLT). PV stents have been attempted in adults with persistent stenosis. However, long-term usefulness of PV stenting is unknown because stents do not expand with growth. We investigated the effect and long-term outcome of PV stenting for stenosis after pediatric LDLT.MethodsWe included patients aged <18 years who underwent LDLT from 1998 to 2020 and who underwent PV stenting for stenosis. We assessed age at procedure, stent complications, and long-term outcomes.ResultsFive patients underwent PV stent placement. The median age at LDLT was 10 years (range, 0.8-18.1 years). The median interval between LDLT and stent placement was 25 months. The median age at stent placement was 16 years (range, 3-20 years). The median body weight was 38 kg (range, 13-63 kg). The median stent diameter was 8 mm. The median observation period after stent placement was 8 years. On average, body weight increased 1.6 times. One complication associated with stent placement was PV thrombosis, which resulted in stent failure, but we observed no portal hypertension. In the other 4 patients, the stent has remained functioning, and there was no clinical evidence of portal hypertension.ConclusionsPV stents are effective for intractable PV stenosis in children. PV stents were successfully placed in children as young as 3 years old and weighing 13 kg. Our data suggests that a stent placed in young children does not cause portal hypertension as patients grow.     

Percutaneous aortic valve replacement: overview and suggestions for anesthestic management

Transcutaneous aortic valve replacement (AVR) is increasingly used for high-risk patients with severe aortic stenosis, who have high operative mortality for surgical placement during cardiopulmonary bypass (CPB). Retrograde transfemoral AVR is usually performed during sedation, whereas antegrade transapical AVR is done with general anesthesia. Both procedures can be carried out without CPB. Extended hemodynamic monitoring, including pulmonary artery catheterization and transesophageal echocardiography, may be useful. Transfemoral AVR requires placement of a transvenous right ventricular pacing lead. Typical complications include local bleeding, obstruction of the coronary ostia, and neurological insult due to embolization of sclerotic material. Aortic regurgitation due to paravalvular leakage or inadequate device expansion also may occur. Renal function may deteriorate on excessive application of contrast medium. Atrioventricular blocks may occur later rather than after conventional AVR which tend to occur immediately.     

Comparison of periprocedure complications resulting from direct stent placement compared with those due to conventional and staged stent placement in the basilar artery

OBJECT: Medically refractory, symptomatic atherosclerotic disease of the basilar artery (BA) portends a poor prognosis. Studies have shown morbidity rates following placement of stents in these lesions to be quite variable, ranging from 0 to 30%. The authors review their experience with BA stent placement for severe atherosclerotic disease to determine whether an increase in neurological morbidity is associated with direct stent placement (that performed without predilation angioplasty) compared with conventional stent placement (that performed immediately after predilation angioplasty) or staged stent placement (angioplasty followed > or = 1 month later by stent placement with or without repeated angioplasty). METHODS: The authors retrospectively reviewed the medical records from a consecutive series of 10 patients who underwent stent placement for medically refractory, symptomatic atherosclerotic disease of the BA between February 1999 and November 2002. Patient records were analyzed for symptoms at presentation, percentage of angiographically visible stenosis, devices used, procedure-related morbidity, and clinical and radiographic outcomes. Patients with symptomatic intracranial vertebral artery stenosis but without concomitant severe (> 50%) BA stenosis were excluded from the study. Four patients were treated with direct stent placement, three with a staged procedure (these were included in a previous publication), and three with conventional stent placement. In the group treated with direct stent placement, a dense quadriparesis developed in two patients after the procedure. Computerized tomography or magnetic resonance imaging revealed infarction of the ventral pons in these patients. In the staged stent placement group, no permanent neurological complications occurred after the procedure and, in the conventional stent placement group, one of three patients experienced a neurological complication involving homonymous hemianopsia. CONCLUSIONS: Direct stent placement in the BA is associated with a relatively high complication rate, compared with a staged procedure. Complications may result from an embolic shower following disruption of atheromatous plaque debris attained using high-profile devices such as stents, as demonstrated by the postoperative imaging appearance of acute pontine infarctions. Additionally, displacement of debris by the stent into the ostia (snowplowing) of small brainstem perforating vessels may be responsible for the complications noted. Although direct stent placement in peripheral and coronary vessels has been shown to be safe, the authors suggest that direct stent placement in the BA should be avoided to minimize the risk of periprocedure morbidity.     

Endoscopic placement of pancreatic stents and drains in the management of pancreatitis.

Although widely used in the biliary tree, little data is available on endoscopic placement of stents or drains within the pancreas. This report describes 17 patients, nine with acute relapsing pancreatitis and eight with chronic pancreatitis, who had drain or stent placement for hypertensive pancreatic duct (PD) sphincter, dominant ductal stenosis, duct disruption, or pseudocyst. Two patients have subsequently undergone surgery, and six other patients continue long-term stent placement with marked reduction of chronic pain or attacks of recurrent pancreatitis. All six pseudocysts resolved, although one recurred and required surgery. It is concluded that pancreatic drains or stents may obviate the need for surgery, temporize before definitive therapy, or direct a subsequent surgical procedure.     

Total anomalous pulmonary venous connection: outcome of surgical correction and management of recurrent venous obstruction

Objective: Total anomalous pulmonary venous connection (TAPVC) can be corrected with low mortality and good outcome. If complicated by pulmonary vein stenosis (PVS), either at presentation or secondary to the repair, the long-term outcome is compromised. We have evaluated an institutional experience with TAPVC, with particular regard to the evolving management of PVS. Methods: Retrospective analysis of 85 consecutive patients with non-isomeric TAPVC undergoing surgical correction over a 10-year period (1988–1997). In addition, three patients were referred to us with secondary PVS, having had their primary procedure elsewhere. Attention was focused on incidence of PVS, and strategies for management. Results: Median age at first operation was 33 days (range 1–533). Site of drainage was supracardiac (43/88), infracardiac (20/88), cardiac (17/88), and mixed (8/88). On presentation, 35% of patients were ventilated. Early mortality was 7% (6/85), with one late non-cardiac death. 82% of the original patients (70/85) are currently well at a median follow-up of 64 months (range 6–119). The incidence of PVS requiring intervention was 11% (9/85). Median time to PVS was 41 days. In these patients, 18 balloon angioplasties, four endovascular stent placements (in two patients), and a further 23 surgical procedures were performed. Of the nine patients undergoing re-intervention after initial surgery at our institution, five (56%) survived. Two of these have no residual obstruction and right ventricular pressure (RVP) <50% systemic, two have unilateral obstruction and RVP <50% systemic, and one has bilateral obstruction and RVP 80% systemic. Of the three patients referred to us with secondary PVS, two are alive and well, and one died early after the first re-operation. Conclusions: Intrinsic obstruction (endocardial sclerosis or thickening) is associated with worse prognosis and earlier re-intervention than extrinsic (anatomical) obstruction. We advocate an early, aggressive approach to the management of patients with TAPVC, especially in the presence of PVS. This complication is most appropriately managed by a combination of re-operation and repeated balloon dilatation.     

Bronchial compression due to stent placement in pulmonary artery in a child with congenital heart disease

Congenital heart disease, such as transposition of the great vessels (TGV), requires surgical procedures which can lead to important complications. We report on a case of bronchial obstruction following placement of a pulmonary artery stent in a 4-year-old boy who had undergone a Rastelli procedure to correct TGV, ventricular septal defect and pulmonary stenosis. There are many complications that can arise as a consequence of intravascular stents in heart surgery, as well as many causes of bronchial compression. However we have not found any report which describes bronchial compression as a direct consequence of endovascular stent.     

The role of airway stenting in pediatric tracheobronchial obstruction

OBJECTIVE: Tracheobronchial obstruction is infrequent in the pediatric age group but it is associated with significant morbidity and mortality. The purpose of this study is to review the results of a single institution experience with endoscopic stent placement in children with benign tracheobronchial obstruction, and with special concern on safety and clinical effectiveness. MATERIALS AND METHODS: Twenty-one patients with severe airway stenosing disease in which stent placement was performed between 1993 and 2006. Inclusion criteria according to the clinical status were: failure to wean from ventilation, episode of apnea, frequent respiratory infections (>3 pneumonia/year), and severe respiratory distress. Additional criteria for stent placement were: failure of surgical treatment, bronchomalacia, and tracheomalacia refractory to previous tracheostomy. Selection of the type of stent depended on the site of the lesion, the patient's age, and the stent availability when time of presentation. The following variables were retrospectively evaluated: age, type of obstruction, associated malformations, stent properties, technical and clinical success, complications and related reinterventions, outcome and follow-up period. RESULTS: Thirty-three stents were placed in the trachea (n=18) and/or bronchi (n=15) of 21 patients with a median age of 6 months (range, 9 days-19 years). Etiology of the airway obstruction included severe tracheomalacia and/or bronchomalacia in 19 cases (90%), and postoperative tracheal stenosis in two. Twelve children had a total of 20 balloon-expandable metallic stents placed, and 10 had 13 silicone-type stents (one patient had both). In nine patients (42%) more than one device was placed. Stent positioning was technically successful in all but one patient. Clinical improvement was observed in 18 patients (85%) but complications occurred in five of them (27%). Eight patients died during follow-up but only in one case it was related to airway stenting. Thirteen patients (62%) are alive and in good condition with a mean follow-up of 39 months (1-13.8 years). CONCLUSIONS: Although the results were based on a small series, placement of stents in the pediatric airway to treat tracheobronchial obstruction seems to be safe and effective. Stenting is a satisfactory therapeutic option when other procedures have failed or are not indicated.     

Endovascular revascularization of renal artery stenosis: technical and clinical results

PURPOSE: The natural history of renal artery stenosis is progression with subsequent deterioration of kidney function and development of renovascular hypertension. Percutaneous transluminal renal angioplasty is effective in the treatment of nonostial lesions but less effective for ostial stenoses. Because of the poor technical success experienced with percutaneous transluminal renal angioplasty, stenting of ostial stenoses is becoming the standard of endovascular care. In this retrospective study we analyzed the technical and clinical outcomes after renal artery stenting in 73 consecutive patients. PATIENTS AND METHODS: From July 1992 to January 1999, 88 Palmaz stents were deployed in 85 renal artery stenoses in 73 patients, with a mean age of 67.9 +/- 9.4 years. Twelve patients (16%) underwent bilateral stent placement. Atheromatous lesions were the most prevalent (99%: 82% ostial, 16% nonostial). Most stents were implanted for suboptimal balloon dilation (52%) or dissection (24%). Mean percent stenosis was 86% +/- 12%. Renal insufficiency (creatinine level > or = 1.5 mg/dL) was present in 50 (68%) patients, and uncontrolled hypertension (systolic > or = 160 mm Hg or diastolic > or = 90 mm Hg with more than two medications) was present in 57 (78%). RESULTS: Primary technical success was achieved in 89%. At the initial procedure, three additional stents were placed for residual stenoses, and urokinase was used to treat one intraprocedural stent thrombosis, resulting in an assisted primary technical success rate of 94%. Major complications occurred in 9.1% of stents placed: access artery thrombosis (n = 4), renal artery extravasation (n = 1), renal artery thrombosis (n = 1), and hematoma requiring operation (n = 2). Long-term clinical data were available on 69 (95%) patients at 20 +/- 17 months. Overall, a significant decrease in systolic and diastolic pressures (P <.001) and reduction of medication (P <.01) were noted without a change in renal function (P = NS). Angiography was performed on 22 patients at 11.3 +/- 10.3 months for persistent or worsening renal function or hypertension or for other reasons; 10 patients had significant restenoses in 14 renal arteries. CONCLUSION: Our retrospective analysis demonstrates that endovascular stenting of renal artery stenosis in patients with poorly controlled hypertension or deteriorating renal function is a safe and effective alternative treatment to surgical management.     

Anesthesia and airway management for removing pulmonary self-expanding metallic stents

The use of bronchoscopically placed self-expanding metallic stents (SEMS) and silastic stents in patients suffering from tracheobronchial stenosis or similar problems has proven to be an important clinical option. When complications occur, it may be necessary to remove the device. Removal of a SEMS is usually performed during general anesthesia with muscle relaxation and positive pressure ventilation, often using total intravenous anesthesia. Airway management depends on stent type and location. Intubating patients' tracheas with a tracheal stent requires special caution, as it risks damaging tissue and dislodging the stent distally. Potential complications with removal include tracheal disruption, retained stent pieces, mucosal tears, re-obstruction requiring new stent placement, the need for postoperative ventilation, pneumothorax, damage to the pulmonary artery, and death.     

Percutaneous transluminal angioplasty and stent placement for recurrent carotid artery stenosis

OBJECT: Treatment consisting of percutaneous transluminal angioplasty (PTA) and stent placement has recently been proposed as an alternative to surgical reexploration in patients with recurrent carotid artery stenosis following endarterectomy. The authors retrospectively reviewed their experience after performing 25 procedures in 21 patients to assess the safety and efficacy of PTA with or without stent placement for carotid artery restenosis. METHODS: The mean interval between endarterectomy and the endovascular procedures was 57 months (range 8-220 months). Seven arteries in five patients were treated by PTA alone (including bilateral procedures in one patient and repeated angioplasty in the same vessel in another). Early suboptimum results and recurrent stenosis in some of these initial cases prompted the authors to combine PTA with stent placement in the treatment of 18 arteries over the past 3 years. No major periprocedural deficits (neurological or cardiac complications) or death occurred. There was one periprocedural transient neurological event, and in one patient a pseudoaneurysm of the femoral artery (at the access site) required surgical repair. In the 16 patients who each underwent at least 6 months of follow-up review, no neurological events ipsilateral to the treated artery had occurred after a mean follow-up period of 27 months (range 6-57 months). Three of five patients who underwent PTA alone developed significant (>50%) asymptomatic restenoses that required repeated angioplasty in one and PTA with stent placement in two patients. Significant restenosis (55%) was observed in only one of the vessels treated by combined angioplasty and stent placement. CONCLUSIONS: Endovascular PTA and stenting of recurrent carotid artery stenosis is both technically feasible and safe and has a satisfactory midterm patency. This procedure can be considered a viable alternative to surgical reexploration in patients with recurrent carotid artery stenosis.     

Long-term results of metallic stents for benign biliary strictures

BACKGROUND: Historically, surgical correction has been the treatment of choice for benign biliary strictures (BBS). Self-expandable metallic stents (MSs) have been useful for inoperable malignant biliary strictures; however, their use for BBS is controversial and their natural history unknown. HYPOTHESIS: To test our hypothesis that MSs provide only short-term benefit, we examined the long-term outcome of MSs for the treatment of BBS. Our goal was to develop a rational approach for treating BBS. DATA EXTRACTION: Between July 1990 and December 1995, 15 patients had MSs placed for BBS and have been followed up for a mean of 86.3 months (range, 55-120 months). The mean age of the patients was 66.6 years and 12 were women. Stents were placed for surgical injury in 5 patients and underlying disease in 10 patients (lithiasis, 7; pancreatitis, 2; and primary sclerosing cholangitis, 1). One or more MSs (Gianturco-Rosch "Z" for 4 patients and Wallstents for 11 patients) were placed by percutaneous, endoscopic, or combined approaches. We considered patients to have a good clinical outcome if the stent remained patent, they required 2 or fewer invasive interventions, and they had no biliary dilation on subsequent imaging. DATA SYNTHESIS: Metallic stents were successfully placed in all 15 patients, and the mean patency rate was 30.6 months (range, 7-120 months). Five patients (33%) had a good clinical result with stent patency from 55 to 120 months. Ten patients (67%) required more than 2 radiologic and/or endoscopic procedures for recurrent cholangitis and/or obstruction (range, 7-120 months). Five of the 10 patients developed complete stent obstruction at 8, 9, 10, 15, and 120 months and underwent surgical removal of the stent and bilioenteric anastomosis. Four of these 5 patients had strictures from surgical injuries. The patient who had surgical removal 10 years after MS placement developed cholangiocarcinoma. CONCLUSIONS: Surgical repair remains the treatment of choice for BBS. Metallic stents should only be considered for poor surgical candidates, intrahepatic biliary strictures, or failed attempts at surgical repair. Most patients with MSs will develop recurrent cholangitis or stent obstruction and require intervention. Chronic inflammation and obstruction may predispose the patient to cholangiocarcinoma.     

Dramatic shift in the primary management of traumatic thoracic aortic rupture

HYPOTHESIS: Traumatic thoracic aortic injury (TAI) is traditionally treated with immediate surgery. Previously published studies have established the safety and efficacy of treating TAI with endovascular stents. Our hypothesis was that stents are supplanting operative repair as the primary therapy for TAI. DESIGN: Retrospective cohort. SETTING: University level I trauma center. PATIENTS AND METHODS: Blunt trauma patients admitted to a level I trauma center diagnosed with TAI between September 1997 and November 2003 were identified from an institutional trauma registry (N = 25). Data were abstracted from medical records and analyzed. Three groups were defined: surgical repair (cardiopulmonary bypass or clamp and sew) (n = 10); medical management (n = 8); and endovascular stent (n = 7). RESULTS: Prior to 2002, 9 (75%) of 12 patients were treated by surgical repair, 2 (17%) by medical management, and 1 (8%) by endovascular stent. Since 2002, 1 patient (8%) was treated by surgical repair, 6 (46%) by medical management, and 6 (46%) by endovascular stent. Injury Severity Scores were comparable between the surgical cohort (mean +/- SEM score, 34.9 +/- 3.4), stent placement (35.1 +/- 3.7), and medical management (29.9 +/- 2.8) (P = .48). Overall survival was 80% with no differences in morbidity or mortality. The stented group had shorter hospital lengths of stay compared with surgical management (28 vs 46 days) (P<.05). The 1 operative case since 2002 was a combined arch/innominate injury that anatomically precluded stent placement. CONCLUSION: Initial reports suggested thoracic aortic stents as an alternative for injured patients with prohibitive operative risks. Our data suggest stent placement is quickly evolving into the primary therapy for TAI across all Injury Severity Score profiles.     

先天性心脏畸形合并肺静脉狭窄的外科治疗

目的 总结先天性心脏畸形合并肺静脉狭窄(CPVS)的外科治疗经验.方法 CPVS病儿5例,平均年龄(8.5±6.4)岁;平均体重(15.2±6.3)kg.术前狭窄段肺静脉前向血流速度(2.3±1.2)m/s,压差(22.0±6.2)mm Hg.入左房处嵴样狭窄肺静脉6支,均行嵴样狭窄环切除术,其中2支同时用肺静脉开口处内膜"纵切横缝"法成形;肺外管状狭窄肺静脉3支,其中1支为单支狭窄,采用新鲜心包补片扩大法,另2支为同一病例的同侧2支肺静脉,采用相关静脉的单元化术式.结果 平均体外循环(129.2±74.6)min、主动脉阻断(74.2±39.1)min,所有病儿术后血流动力学稳定,肺静脉前向血流速度(0.7±0.4)m/s,压差(2.0±0.6)mm Hg.平均术后住院(10±3)d.随访6个月～3年,结果满意.结论 CPVS往往合并其他先心病,病情重,宜早期诊治.内膜"纵切横缝"法及相邻狭窄肺静脉的"单元化"术式是新的手术方法,技术上是可行的.治疗时可综合应用多种方法,力求彻底解决狭窄并保持其生长潜能;术后早、中期疗效满意.     

Treatment of Complex Airway Lesions After Lung Transplantation With Self-Expandable Nitinol Stents: Early Experience

Airway complications (AC) are considered a serious cause of morbidity after lung transplantation (LT). Mechanical dilatation, laser vaporization, and silicone stent placement usually solve it. However, the use of self-expandable metallic stents (SENS) may be indicated in selected cases. Ten lung transplant recipients with AC were treated with SENS. Six patients underwent LT for cystic fibrosis, 2 for idiopathic pulmonary fibrosis, 1 for bronchiectasis, and 1 for emphysema. All patients received at least 1 treatment attempt with dilatation and silicone stent placement. The indications for SENS placement were the presence of a tortuous airway axis with stenosis and malacia of the right main bronchus in 5 patients; a long stenosis of the main and intermediate right bronchus involving the upper lobe orifice in 3 patients; or malacia that could not be stabilized with silicone stents in 3 cases. In 1 patient the procedure was bilateral. Functional improvement was immediate with a mean forced expiratory volume at 1 second (FEV₁) gain of 35%. No stent dislocation was observed. Symptoms did not occur again in 5 patients with previous recurrent episodes of pneumonia. One stenosis, which was due to the ingrowth of granulation tissue occurred at 6 months after the procedure, was successfully treated with mechanical dilatation and laser vaporization. The deployment of SENS in a selected group of patients with AC after LT was easy, safe, and effective.     

Transluminal vascular stent implantation for a patient with renovascular hypertension due to renal artery stenosis

In recent years, transluminal vascular stents have been implanted in patients with renal artery stenosis. At present, controversy remains as to whether the long-term outcome of stent implantation is better than that of percutaneous transluminal renal angioplasty (PTRA). However, until now, no clinical experience of a stent placement for renal artery stenosis has been reported in our country. We implanted a Palmaz stent in a patient with renovascular hypertenstion due to renal artery restenosis who had already undergone PTRA. The renal function and blood pressure of the patient improved remarkably.     

Granulation stenosis caused by a Dumon stent placed for endobronchial tuberculous stenosis

Two patients with cicatric tracheobronchial stenosis caused by tuberculosis who suffered granulation stenosis after placement of a Dumon stent are reported. Dumon stents, which were long enough to cover the stenotic sites, were placed in the trachea and left main bronchus of each patient. Granulation tissue grew at both edges of the stent 3 or 4 months after stent placement, which caused restenosis and necessitated removal of the stents. The authors conclude that a Dumon stent for treatment of tracheobronchial stenosis caused by tuberculosis can cause granulation stenosis at the edges of the stent.     

球囊扩张联合覆膜支架植入治疗人造血管动静脉内瘘狭窄

目的 探讨球囊扩张联合覆膜支架植入治疗人造血管动静脉内瘘(AVG)狭窄的临床疗效.方法 前瞻性选取15例经皮腔内血管成型术(PTA)疗效欠佳的AVG狭窄患者,且具备以下特点:狭窄长度不超过7 cm,狭窄程度大于50％;PTA后3个月内狭窄复发2次或以上;扩张后残余狭窄＞30％或狭窄部位立即弹性回缩.所有患者在数字减影血管造影(DSA)下行球囊扩张后植入不同内径的聚四氟乙烯覆膜支架.结果 男3例,女12例,平均年龄(66±12)岁.支架植入前内瘘平均使用时间为(19.5±15.0)个月.共植入支架16枚,技术成功率100％,植入部位为静脉吻合口9例(9/15);静脉流出道6例(6/15),其中头静脉3例,肱静脉2例,腋静脉1例.首次开通率3个月为40％,6个月为19％,12个月为13％.再次开通率3个月为93％,6个月为88％,12个月为87％.术后平均随访时间为(14.9±5.3)个月,再窄狭率为87％(13/15).术后PTA 36例次,支架内狭窄36％ (13/36);支架远端狭窄8％ (3/36);支架近端狭窄22％(8/36);与支架无关的狭窄33％ (12/36).AVG中位生存时间为25个月.结论 球囊扩张联合覆膜支架植入治疗AVG狭窄技术成功率高,并发症少,首次开通率不高,但再次开通率令人满意.