ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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 andassisted 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.
ABSTRACT
Objective To evaluate the feasibility and value of multi-detector computed tomography venography (MDCTV) and three dimensional reconstruction image in the assessment of central venous occlusive disease in hemodialysis patients,and in the value of guiding interventional treatments.Methods Sixty hemodialysis patients with swelling of upper limbs were scanned by Toshiba 128-multislice spiral computed tomography (128-MSCT) and totally 80-100 ml non-ionic contrast media was injected into each of the patients via the peripheral veins of the contralateral limb with the rate of 4 ml/s.MSCT scanning was taken by the technique of intelligent triggering after setting scanning triggering threshold,with the monitoring point set in the development of the lumen of inferior vena cava,to detect the position and degree of vascular stenosis.The images were reformed as maximum intensity projection (MIP),volume rendering (VR),curved planar reformation and threedimensional image reconstruction technique.Results MDCTV clearly demonstrated the lesion location in all cases enrolled.Seventy-five occlusive lesions were detected in the total of 60 hemodialysis patients with swelling of upper limbs by MDCTV,of which the lesions of brachiocephalic vein was 47,superior vena cava 15 and subclavian vein 13.Among the 75 stenosis lesions,the number of complete occlusive,severe,moderate and mild stenosis was 31,24,19 and only 1,respectively.MDCTV provided information coincident with that of digital subtraction angiography (DSA),which the correlation index was 0.401,while DSA showed that number of complete occlusive,severe,moderate and mild stenosis was 49,7,14 and 5,respectively.Pereutaneous transluminal angioplasty was performed in 53 patients,and stent placement was done in 40 patients.After interventional treatments,swelling of upper limbs were obviously relieved and vascular accesses got functional recovery to the extent that they could meet the requirement of hemodialysis.Conclusions MDCTV is the first choice to evaluate the condition of central venous occlusive diseases of hemodialysis patients with advantages of non-invasion,high definition and three-dimensional reconstruction.It can provide accurate evaluations of the conditions of occlusive lesions,which can be of great clinical significance to subsequent interventional therapy.