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Abstract：
To assess the efficacy of stent grafts (SGs) in managing central venous obstruction disease (CVOD) in hemodialysis (HD) patients with arteriovenous (AV) access, and to identify predictive factors influencing the SG treatment outcomes. HD subjects with CVOD who underwent SGs placement at our center between August 2018 and June 2022 were enrolled. Survival curve analysis using the Kaplan-Meier method and log-rank test was performed. Cox proportional hazards regression analysis was employed to identify predictive factors associated with outcomes. A total of 59 SG implantation procedures for CVOD were analyzed, comprising 30 cases of stenosis and 29 cases of occlusion. The access circuit primary patency (ACPP) at 6, 12, and 24 months post-SG placement were 80.9%, 53.8%, and 31.4%, respectively, while, the target lesion primary patency (TLPP) were 91.3%, 67.6%, and 44.5%, respectively. Subgroup analysis revealed higher TLPP in the stenosis group compared to the occlusion group, although the difference was not statistically significant (P = 0.165). The TLPP was significantly improved by SG placement in those who had antecedent balloon dilations (P < 0.001). Cox proportional hazards regression identified target lesion length ≥ 30 mm and procedure defects as independent predictors of lower TLPP after SG treatment for CVOD in HD patients. SG placement demonstrates safety and efficacy in managing CVOD among HD patients, leading to improved TLPP of endovascular therapy (EVT) for CVOD. Notably, long target lesions (≥ 30 mm) and procedure defects emerged as predictive factors influencing TLPP.
摘要：
评估支架移植物（SGs）在血液透析（HD）患者动静脉（AV）介入治疗中心静脉阻塞疾病（CVOD）中的疗效。并确定影响SG治疗结果的预测因素。纳入2018年8月至2022年6月在我们中心接受SGs安置的患有CVOD的HD受试者。使用Kaplan-Meier方法和对数秩检验进行生存曲线分析。采用Cox比例风险回归分析来确定与结果相关的预测因素。总共分析了59例用于CVOD的SG植入手术，其中狭窄30例,闭塞29例。SG放置后6、12和24个月的接入电路主要通畅率（ACPP）为80.9%，53.8%,和31.4%，分别,while,靶病变原发通畅率(TLPP)为91.3%,67.6%,和44.5%，分别。亚组分析显示，狭窄组的TLPP高于闭塞组，虽然差异无统计学意义(P=0.165)。在先前有球囊扩张的患者中，通过SG放置，TLPP显着改善（P<0.001）。Cox比例风险回归将靶病变长度≥30mm和手术缺陷确定为HD患者SG治疗CVOD后TLPP降低的独立预测因子。SG放置证明了在HD患者中管理CVOD的安全性和有效性，改善CVOD血管内治疗（EVT）的TLPP。值得注意的是,长目标病灶(≥30mm)和手术缺陷是影响TLPP的预测因素。
