ABSTRACT
PURPOSE: To present final, 2-year data from randomized comparison of an expanded polytetrafluoroethylene stent graft (SG) and percutaneous transluminal angioplasty (PTA) for treatment of arteriovenous graft (AVG) anastomotic stenoses. MATERIALS AND METHODS: A 28-site, prospective, controlled US study enrolled 270 patients with malfunctioning AVG anastomotic stenoses of ≥ 50%; 138 patients underwent SG placement, and 132 underwent PTA alone. Follow-up imaging and intervention were event-driven. RESULTS: The study was completed by 191 patients (97 SG, 94 PTA). Five patients were lost to follow-up or withdrew; 74 patients died during the study (38 SG, 36 PTA). At 12 months, treatment area primary patency (TAPP) was SG 47.6% versus PTA 24.8% (P < .001), access circuit primary patency (ACPP) was SG 24% versus PTA 11% (P = .007), and index of patency function (IPF) was SG 5.2 months/intervention ± 4.1 versus PTA 4.4 months/intervention ± 3.5 (P = .009). At 24 months, TAPP was SG 26.9% versus PTA 13.5% (P < .001), ACPP was SG 9.5% versus PTA 5.5% (P = .01), and IPF was SG 7.1 months/intervention ± 7.0 versus PTA 5.3 months/intervention ± 5.2; estimated number of reinterventions before graft abandonment was 3.4 for SG patients versus 4.3 for PTA patients. There were no significant differences in adverse events (P > .05) except for restenosis requiring reintervention rates of 82.6% in PTA patients versus 63.0% in SG patients (P < .001). CONCLUSIONS: At 2 years, SG use provided a sustained, greater than 2-fold advantage over PTA in treatment area and overall access patency. Time to subsequent intervention was longer in the SG group.
Subject(s)
Angioplasty, Balloon , Arteriovenous Shunt, Surgical/adverse effects , Graft Occlusion, Vascular/therapy , Renal Dialysis , Aged , Angioplasty, Balloon/adverse effects , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/instrumentation , Female , Graft Occlusion, Vascular/diagnostic imaging , Graft Occlusion, Vascular/etiology , Graft Occlusion, Vascular/physiopathology , Humans , Male , Middle Aged , Polytetrafluoroethylene , Product Surveillance, Postmarketing , Prospective Studies , Prosthesis Design , Retreatment , Stents , Time Factors , Treatment Outcome , United States , Vascular PatencyABSTRACT
PATIENT: Female, 50 FINAL DIAGNOSIS: Double superior vena cava Symptoms: - MEDICATION: - Clinical Procedure: - Specialty: Nephrology. OBJECTIVE: Anatomical anomaly/variation. BACKGROUND: Superior vena cava anomalies are caused by variations in the development of the embryonic thoracic venous system. Duplication of the superior vena cava is a rare anomaly with an incidence in the general population of 0.3%. The majority of cases are asymptomatic and diagnosed incidentally by imaging done for another reason. CASE REPORT: A fifty year old female patient presented to our care with a history of end stage renal disease that has been recently started on dialysis. Procedures performed included a fistulogram, PermaCath placement and angiogram of internal jugular vein. Angiogram was done and showed that the patient has a good sized cephalic vein which is wide open and mild to moderate stenosis at the subclavian area which proved to be a dual superior vena cava. CONCLUSIONS: Double SVC is a rare congenital anomaly. The literature available on this congenital anomaly is sparse. The majority of cases are diagnosed incidentally on imaging for other reasons, which can alert the physician of other congenital abnormalities that will need further work up. However, these venous anomalies should be recognized, as they can have significant clinical implications, especially during central venous catheter placement, radiofrequency ablation, pacemaker insertion or coronary artery bypass graft.
