覆膜支架与裸支架治疗人工血管动静脉内瘘静脉吻合口狭窄的疗效

Clinical effectiveness of stent-graft versus bare metal stent in treating venous anastomotic stenosis of arteriovenous graft

目的探讨覆膜支架与裸支架治疗静脉吻合口狭窄导致人工血管动静脉内瘘(AVG)失功的临床疗效。方法收集中日友好医院于2011年1月至2019年1月收治的65例因静脉吻合口狭窄导致AVG失功患者的临床资料,根据手术方式不同将患者分为覆膜支架植入组(n=31)和裸支架植入组(n=34),比较两组患者的治疗效果。结果两组患者的手术成功率均为100%。两组患者的术后1年初级通畅率、累积通畅率,2年初级通畅率、累积通畅率,以及1年支架内初级通畅率比较,差异均无统计学意义(P>0.05)。覆膜支架植入组患者的2年支架内初级通畅率高于裸支架植入组患者(P=0.027)。Cox回归分析结果显示,覆膜支架是发生支架内狭窄的保护因素(P=0.032)。覆膜支架植入组与裸支架植入组的技术成功率均为100%,围手术期病死率均为0%。随访2年,覆膜支架植入组支架内狭窄发生率低于裸支架植入组(P<0.05)。两组患者在支架植入后发生中心静脉相关疾病方面比较,差异无统计学意义(P>0.05)。结论与覆膜支架相比,金属裸支架支架内狭窄的发生率更高,两种治疗方案人工血管通畅率无明显差别,在治疗AVG静脉吻合口狭窄上均是切实可行的治疗方案。

Objective To assess the clinical effectiveness of stent-graft versus bare metal stent in treating venous anastomotic stenosis of arteriovenous graft(AVG).Method Clinical data of 65 patients with arteriovenous fistula failure due to venous anastomotic stenosis admitted to China-Japan Friendship Hospital between January 2011 and January 2019 were collected.According to different surgical methods,the patients were divided into stent-graft group(n=31)and bare metal stent group(n=34).Result Technical success was 100%.The differences in the postoperative 1-year primary patency,1-year cumulative patency,2-year primary patency,and 2-year cumulative patency ratio,as well as in-stent primary patency in 1 year were not statistically significant between the treatments(P>0.05).The 2-year instent primary patency was higher in stent-graft group than that in bare metal stent group(P=0.027).Cox regression showed that stent-graft protected patients from in-stent restenosis(P=0.032).During the 2 years post-stent follow-up,the incidence rate of in-stent restenosis was lower in stent-graft group than that in in bare metal stent group(P<0.05).The difference in the incidence of post-stent central vein diseases was not statistically significant(P>0.05).Conclusion Patients with bare metal stent are more likely to suffer from in-stent restenosis compared with those with stent-graft,but there is no significant difference in patency between the two treatments.Both strategies are feasible in treating venous anastomotic stenosis of AVG.