中国普通外科杂志2025，Vol.34Issue(12)：2664-2671,8.DOI:10.7659/j.issn.1005-6947.250617
不同静脉入路策略在血液透析患者中心静脉狭窄或闭塞腔内治疗中的比较研究
Comparison of venous access strategies for endovascular management of central venous stenosis or occlusion in hemodialysis patients
摘要
Abstract
Background and Aims:Central venous stenosis or occlusion(CVSO)compromises the effectiveness of hemodialysis;however,the optimal venous access strategy remains unclear.This study compared the applicability,technical success rates,and clinical success rates of unidirectional venous access(UVA)and bidirectional venous access(BVA)in maintenance hemodialysis patients with CVSO undergoing percutaneous transluminal angioplasty(PTA)or percutaneous transluminal stenting(PTS).Stratified analyses were performed according to lesion location and type,aiming to establish individualized venous access selection criteria for different lesion subtypes. Methods:A retrospective analysis was conducted on the clinical data of 63 maintenance hemodialysis patients with CVSO treated between July 2019 and February 2024 at the First Affiliated Hospital of Gannan Medical University and the Second Affiliated Hospital of Nanchang University,including 37 patients in the UVA group and 26 patients in the BVA group.Technical success(residual stenosis<30%),clinical success(symptom relief),and patency outcomes of different venous access strategies in the endovascular treatment of CVSO were compared. Results:Baseline characteristics were comparable between the two groups(all P>0.05).No significant differences were observed in overall technical or clinical success rates(both P>0.05).Subgroup analysis demonstrated that the UVA group achieved a higher technical success rate in superior vena cava and brachiocephalic vein stenosis compared to the BVA group,along with a better clinical success rate specifically in brachiocephalic vein stenosis,whereas BVA was associated with significantly higher technical and clinical success rates in subclavian vein occlusion(all P<0.05).No significant differences were found in primary or secondary patency rates at 6 and 12 months(all P>0.05). Conclusion:UVA is preferable for stenotic lesions of the superior vena cava and brachiocephalic vein,whereas BVA should be prioritized for subclavian vein occlusion.Tailoring venous access strategies according to lesion location and type may enhance procedural success in endovascular treatment of CVSO.关键词
血管通路装置/手术后并发症/血管成形术/支架Key words
Vascular Access Devices/Postoperative Complications/Angioplasty/Stents分类
医药卫生引用本文复制引用
方萃福,唐莹,刘凤恩,付利锋,陈居正,周为民,段青..不同静脉入路策略在血液透析患者中心静脉狭窄或闭塞腔内治疗中的比较研究[J].中国普通外科杂志,2025,34(12):2664-2671,8.基金项目
江西省卫生健康委科技计划基金资助项目(202210909) （202210909）
赣南医科大学第一附属医院博士科研启动基金资助项目(QD202317). （QD202317）
