Long-Term Outcome of a "Mother-Child" Coaxial Dual-Catheter Technique for Percutaneous Transluminal Angioplasty of Central Vein Stenosis or Occlusion in Hemodialysis Patients

作者全名："Lai, Qi-Quan; Zhang, Hui; Zhou, Yu; Chen, Bo; Hu, Bo; He, Fan; Xu, Yong; Zhao, Wen-Bo; Wan, Zi-Ming"

作者地址："[Lai, Qi-Quan; Zhou, Yu; Wan, Zi-Ming] Chongqing Med Univ, Affiliated Hosp 1, Dept Nephrol, Chongqing, Peoples R China; [Zhang, Hui] Chongqing Med Univ, Affiliated Hosp 1, Dept Med, Chongqing, Peoples R China; [Chen, Bo] Chongqing Med Univ, Affiliated Hosp 1, Dept Ultrasonog, Chongqing, Peoples R China; [Hu, Bo] Jinan Univ, Affiliated Hosp 1, Dept Nephrol, Jinan, Guangdong, Peoples R China; [He, Fan] Huazhong Univ Sci & Technol, Tongji Hosp, Tongji Med Coll, Dept Nephrol, Wuhan, Peoples R China; [Xu, Yong] Cent South Univ, Xiangya Hosp 3, Dept Nephrol, Changsha, Peoples R China; [Zhao, Wen-Bo] Sun Yat Sen Univ, Affiliated Hosp 3, Dept Nephrol, Guangzhou, Peoples R China; [Wan, Zi-Ming] Chongqing Med Univ, Affiliated Hosp 1, Dept Nephrol, 1 Youyi Rd, Chongqing 400042, Peoples R China"

通信作者："Wan, ZM (通讯作者)，Chongqing Med Univ, Affiliated Hosp 1, Dept Nephrol, 1 Youyi Rd, Chongqing 400042, Peoples R China."

来源：JOURNAL OF ENDOVASCULAR THERAPY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:000886381200001

JCR分区：Q2

影响因子：2.6

年份：2022

卷号：　

期号：　

开始页：　

结束页：　

文献类型：Article; Early Access

关键词：central vein; stenosis; percutaneous transluminal angioplasty; coaxial dual-catheter; hemodialysis

摘要："Purpose: This study aims to evaluate the long-term outcome and prognostic factors of a ""mother-child"" coaxial dual-catheter technique for percutaneous transluminal angioplasty (PTA) in the treatment of central vein stenosis (CVS) or central vein occlusion (CVO). Materials and Methods: During September 2017 to August 2020, totally, 76 hemodialysis patients with symptomatic CVS or CVO were treated with PTA using the mother-child technique. The success rate, complications, and follow-up information were collected. Cox proportional hazard analysis was used to explore the predicting factors of primary patency. Primary patency rates of different subgroups were generated with the Kaplan-Meier analysis and compared using the log-rank (Mantel-Cox) test. Results: There were 31 CVS patients and 45 CVO patients who presented with 114 PTAs. The initial procedure success rate was 98.25%. By the end of the follow-up, 57 patients (75%) had maintained functioning fistula after initial or repeated PTAs. The primary patency rates were 88.75% at 3 months, 73.36% at 6 months, 55.83% at 12 months, and 50.75% at 18 months. The secondary patency rates were 97.14% at 6 months, 87.66% at 12 months, and 82.18% at 24 months. The predictors for primary patency were history diabetes mellitus (hazard ratio [HR] = 3.1, 95% confidence interval [CI]: 1.31-7.30, P = .010), abnormal white blood cell count (HR = 1.44, 95% CI: 1.18-1.75, P < .001), lesion at subclavian-innominate vein (HR=2.75, 95% CI: 1.34-5.63, P = .006), and occlusion (HR=0.33, 95% CI: 0.14-0.76, P = .010). The primary patency was significantly lower in the subclavian-innominate vein subgroup, with a median primary patency of 4.5 (3-12.75) months, than in the nonsubclavian-innominate vein subgroup (8.5 [5-13] months; P = .005). The median duration of each PTA was 8 months for the first PTA, 7.5 months for the second PTA, and 5 months for the third PTA. There was no significant difference in the patency duration of repeated PTAs and the primary PTA (P = .389). Conclusions: The mother-child coaxial dual-catheter technique has a good success rate and acceptable primary patency in the treatment of hemodialysis patients with CVS or CVO. Repeated PTA is as effective as the primary PTA. Clinical Impact This is the follow up report on the ""Mother-Child"" coaxial dual-catheter technique for percutaneous transluminal angioplasty of central vein stenosis or occlusion in hemodialysis patients since we first presented it in 2019. In this paper, we can see that the long-term patency rate of this technique for central venous disease is satisfactory, and repeated use of this technique does not affect the patency time. Compared with other literature reports, the surgical success rate of this technique is significantly improved. Therefore, this technique is worth popularizing in the treatment of central venous disease."

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