Time to symptomatic vascular stenosis at different locations in patients with arteriovenous grafts
Time to symptomatic vascular stenosis at different locations in patients with arteriovenous grafts
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DOI：
10.1111/j.1525-139x.2008.00436.x
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发表时间：
2008-05-01
影响因子：
1.6
通讯作者：
Allon, Michael
中科院分区：
文献类型：
--
作者：
Bozof, Ryan;Kats, Mark;Allon, Michael
大多数动静脉移植物由于不可逆的血栓形成而失败，加上血流动力学显着的血管狭窄。先前的研究观察到静脉吻合处的狭窄频率最高，但没有解决狭窄的时间。本研究量化了不同血管位置出现症状性狭窄的时间，并将其与永久性移植失败联系起来。回顾性查询前瞻性计算机化血管通路数据库，以确定 4 年期间在一家大型透析中心接受新上肢移植物的 309 名血液透析患者。对于每个血管部位，我们使用生存技术计算出现症状性狭窄的时间。 2 年时出现症状性狭窄的累积可能性为，静脉吻合口狭窄为 67%，移植物内狭窄为 19%，静脉出口狭窄为 16%，中央静脉狭窄为 13%，动脉吻合口狭窄为 5%。 2 年移植失败的累积风险为 40%。静脉吻合处狭窄的可能性是累积移植失败的两倍（风险比 [HR] 1.95；95% 置信区间 [CI]，1.65-2.52，p < 0.001）。相比之下，移植物内狭窄的可能性是累积移植物失败的一半（HR 0.45；95% CI，0.36-0.61，p < 0.001）。与没有同侧导管的患者相比，先前有同侧导管的患者更容易发生中央静脉狭窄（HR 2.40；95% CI，1.39-5.58，p = 0.004）。与其他血管部位相比，静脉吻合处出现症状性狭窄要早得多。此外，先前存在的同侧颈内透析导管使中央静脉狭窄的风险增加一倍以上。
Most arteriovenous grafts fail due to irreversible thrombosis, superimposed on hemodynamically significant vascular stenosis. Previous studies observed the highest frequency of stenosis at the venous anastomosis, without addressing the timing of stenosis. The present study quantified time to symptomatic stenosis at different vascular locations, and related it to permanent graft failure. A prospective computerized vascular access database was queried retrospectively to identify 309 hemodialysis patients receiving new upper extremity grafts during a 4-year period at a large dialysis center. For each vascular site we calculated the time to symptomatic stenosis using survival techniques. The cumulative likelihood of symptomatic stenosis at 2 years was 67% for venous anastomotic stenosis, 19% for intra-graft stenosis, 16% for venous outlet stenosis, 13% for central vein stenosis, and 5% for arterial anastomotic stenosis. The cumulative risk of graft failure at 2 years was 40%. Stenosis at the venous anastomosis was twice as likely as cumulative graft failure (hazard ratio [HR] 1.95; 95% confidence interval [CI], 1.65-2.52, p < 0.001). In contrast, intra-graft stenosis was half as likely as cumulative graft failure (HR 0.45; 95% CI, 0.36-0.61, p < 0.001). Central vein stenosis was more likely in patients with a previous ipsilateral catheter compared with those without one (HR 2.40; 95% CI, 1.39-5.58, p = 0.004). Symptomatic stenosis occurs much earlier at the venous anastomosis compared with other vascular sites. Moreover, preexisting ipsilateral internal jugular dialysis catheters more than double the risk of central vein stenosis.