支架植入治疗血液透析相关中心静脉病变效果及影响通畅率的因素

The efficacy of stent implantation for hemodialysis-related central venous diseases and the risk factors affecting the patency rate

目的 探讨支架植入治疗血液透析(血透)相关中心静脉病变(CVD)的效果,分析影响通畅率的因素。方法 纳入2015年12月至2020年3月重庆医科大学附属第一医院金山医院收治的因血透相关CVD接受腔内支架植入术患者,收集一般资料、手术信息、术后随访情况,分析影响通畅率的因素。结果 共纳入89例患者,根据支架类型分为覆膜支架组(n=70)和裸支架组(n=19),覆膜支架又分为Viabahn(n=17)和Fluency(n=53)。术后3、6、12、24个月初级通畅率和次级通畅率在覆膜支架组分别为97.1%、88.6%、71.4%、55.7%和100%、98.6%、94.3%、85.7%,裸支架组分别为84.2%、57.9%、21.1%、15.8%和100%、100%、84.2%、47.4%,两组间比较差异均有统计学意义(均P<0.01)。Viabahn支架初级通畅率优于Fluency支架(P=0.044),次级通畅率差异无统计学意义(P=0.061)。多因素分析显示,覆膜支架长度与初级通畅率相关(OR=2.162,95%CI=1.248~5.764,P=0.048),支架长度越长初次通畅率越低。结论 支架植入治疗血透相关CVD安全有效。覆膜支架通畅率优于裸支架,Viabahn通畅率优于Fluency。支架长度是影响覆膜支架通畅率的危险因素。

Objective To explore the effect of stent implantation in the treatment of hemodialysis-related central venous disease(CVD),and to analyze the factors affecting the patency rate.Methods The clinical materials,including general data,surgical information,and postoperative follow-up results,of the patients with hemodialysis-related CVD,who received percutaneous transluminal stenting at the Jinshan Hospital of First Affiliated Hospital of Chongqing Medical University of China between December 2015 and March 2020,were retrospectively collected.The factors that affected the patency rate were analyzed Results A total of 89 patients were included in this study.Based on the type of the stent used,the patients were divided into covered stent group(n=70)and bare stent group(n=19).The covered stent group was further subdivided into Viabahn stent subgroup(n=17)and Fluency stent subgroup(n=53).In the covered stent group,the postoperative 3-,6-,12-and 24-month primary patency rates were 97.1%,88.6%,71.4%and 55.7%respectively,the secondary patency rates were 100%,98.6%,94.3%and 85.7%respectively;in the bare stent group,the postoperative 3-,6-,12-and 24-month primary patency rates were 84.2%,57.9%,21.1%and 15.8%respectively,the secondary patency rates were 100%,100%,84.2%and 47.4%respectively;the differences in the primary and secondary patency rates between the two groups were statistically significant(all P<0.01).The primary patency rate in Viabahn stent subgroup was better than that in Fluency stent subgroup(P=0.044),while no statistically significant difference in the secondary patency rate existed between the two subgroups(P=0.061).Multivariate analysis showed that the length of the covered stent was correlated with the primary patency rate(OR=2.162,95%CI-1.248-5.764,P-0.048),which indicated that the longer the stent length was,the lower the primary patency rate would be.Conclusion For the treatment of hemodialysis-related CVD,stent implantation is clinically safe and effective.In terms of stent patency,covered stent is better than bare stent,and Viabahn stent is better than Fluency stent.The stent length is a risk factor that affects the patency of covered stents.