覆膜支架治疗血液透析患者动静脉通路并发症的临床结局

Clinical outcomes of hemodialysis patients with stent grafts for treating the complications of arteriovenous access

目的分析真实世界下血液透析(hemodialysis,HD)患者因动静脉通路并发症应用覆膜支架的临床结局。方法这是一项回顾性队列研究,收集郑州大学第一附属医院2018年8月1日至2021年12月31日使用覆膜支架治疗动静脉通路并发症的HD患者的临床资料,采用Kaplan-Meier生存分析和Log-rank检验分析总体及各亚组覆膜支架术后靶病变的一期通畅(target lesion primary patency,TLPP)、靶病变一期辅助通畅(target lesion primary assisted patency,TLPAP)及通路的一期通畅(access circuit primary patency,ACPP)情况,并比较覆膜支架置入前后TLPP及年平均干预次数。结果根据入排标准共纳入71例患者77枚覆膜支架,其中自体动静脉内瘘(arteriovenous fistula,AVF)46例次(59.7%),移植物动静脉内瘘(arteriovenous graft,AVG)31例次(40.3%),中位随访时间22.4个月。覆膜支架置入后6个月、12个月、24个月和36个月的TLPP分别为89.3%、66.5%、48.3%和42.5%,TLPAP分别为94.8%、90.4%、78.7%和75.4%,ACPP分别为77.2%、54.3%、35.2%和29.0%。亚组分析时,中心静脉、头静脉弓、AVG静脉吻合口或流出道三个不同部位覆膜支架的TLPP差异无统计学意义(χ^(2)=0.086,P=0.808),单纯狭窄组TLPP优于血栓/闭塞组,但差异无统计学意义(χ^(2)=2.551,P=0.110)。与置入前相比,置入覆膜支架后TLPP得到显著改善(χ^(2)=7.484,P=0.006),中位通畅时间由16.6个月增加到23.2个月,通路年平均干预次数从0.99(0.10,1.83)次下降到0.50(0,1.45)次(Z=-2.841,P=0.004)。结论HD患者动静脉通路并发症应用覆膜支架后TLPP明显改善,年平均干预次数显著减少。

Objective To investigate the clinical outcomes of hemodialysis(HD)patients with stent grafts for arteriovenous access complications in real-world.Methods It was a retrospective cohort study.Clinical data of HD patients treated with stent grafts for arteriovenous access complications from August 1,2018 to December 31,2021 in the First Affiliated Hospital of Zhengzhou University was collected to analyze target lesion primary patency(TLPP),target lesion primary assisted patency(TLPAP),and access circuit primary patency(ACPP)using the Kaplan-Meier survival analysis and Log-rank test,and to compare TLPP and mean annual intervention times between pre-stent grafts and post-stent grafts placement.Results A total of 77 stent grafts in 71 patients were included according to the inclusion criteria,of which 46(59.7%)were arteriovenous fistula(AVF)and 31(40.3%)were arteriovenous graft(AVG),with a median follow-up time of 22.4 months.At 6,12,24,and 36 months after stent grafts deployment,TLPP was 89.3%,66.5%,48.3% and 42.5%,respectively.TLPAP was 94.8%,90.4%,78.7% and 75.4%,respectively.And ACPP was 77.2%,54.3%,35.2% and 29.0%,respectively.At subgroup analysis,there was no difference in TLPP at the three different sites of central vein,cephalic arch,and AVG venous anastomosis or outflow tract(χ^(2)=0.086,P=0.808).TLPP was better in the stenosis group than thrombosis or occlusion group,but was not statistically significant(χ^(2)=2.551,P=0.110).Compared with pre-stent grafts,TLPP improved significantly(χ^(2)=7.484,P=0.006),the median patency time increased from 16.6 months to 23.2 months,and the mean annual intervention times decreased from 0.99(0.10,1.83)to 0.50(0,1.45)(Z=-2.841,P=0.004)after stent grafts placement Conclusion The TLPP of HD patients with stent grafts for arteriovenous access complications improves significantly,and the mean annual intervention times reduce significantly.