Title: Stent graft deployment in haemodialysis fistula: patency rates in partially thrombosed aneurysm and residual thrombi.

Background: Current evidence is insufficient to determine the contribution of stent grafts as treatment in partially thrombosed aneurysms or residual wall-adherent thrombi in arteriovenous fistulae (AVFs) for haemodialysis. The overall purpose of this study was to analyse patency rates of post-interventional covered stent deployment in those cases. We also assessed if patency rates differed when fistulas were punctured through the stent during dialysis sessions.

Methods: We conducted a retrospective study between 2006 and 2014 analysing post-intervention primary patency rates using the Kaplan-Meier log-rank test. Multivariate Cox proportional regression models were performed to determine if cannulation within the stent graft area was a potential risk factor for occlusion, by adjusted hazard ratio (HR).

Results: A total of 27 procedures were included in the study. Primary patency rates (%) after stent deployment at 3, 6, 12, 24, 36 and 72 months were, respectively: total 59, 32, 32, 21, 11 and 5; stent puncture 53, 21, 21, 16, 5 and 0; and no stent puncture 80, 80, 80, 40, 40 and 40. Cannulation through the stent graft was not significantly associated with increased risk of obstruction in multivariate analysis (HR = 3.01; P = 0.286).

Conclusion: Stent graft treatment may be a feasible procedure in partially thrombosed aneurysms and residual thrombi in AVF. Although fistulas punctured through the stent presented lower patency rates, this practice was not associated with a higher risk of obstruction. Giving the impossibility of comparing with similar approaches, further studies are needed to confirm or refute the advantages of this procedure.

Source: García-Medina J, Maldonado-Cárceles AB, García-Alfonso JJ, et al. Stent graft deployment in haemodialysis fistula: patency rates in partially thrombosed aneurysm and residual thrombi[J]. Clin Kidney J, 2021, 14(3):814-819. DOI: 10.1093/ckj/sfz193.

背景：目前的证据不足以确定支架植入物在进行血液透析的动静脉内瘘（AVFs）中部分血栓性动脉瘤或残留壁粘附血栓的治疗中的作用。这项研究的总体目的是分析在这些情况下，介​​入后覆膜支架展开的通畅率。我们还评估了在透析过程中通过支架穿刺瘘管时通畅率是否有所不同。

方法：我们在2006年至2014年之间进行了一项回顾性研究，使用Kaplan-Meier对数秩检验对干预后的主要通畅率进行了分析。通过调整风险比（HR），进行了多变量Cox比例回归模型，以确定支架移植物区域内的穿刺是否是阻塞的潜在危险因素。

结果：总共27例对象被纳入研究。支架置入后3、6、12、24、36和72个月时的主要通畅率（％）分别为：总计59％、32％、32％、21％、11％和5％。其中，支架穿刺53％、21％、21％、16％、5％和0％;而没有支架穿刺发生80％、80%、80%、40%、40%和40%。在多变量分析中，通过支架移植物进行穿刺与阻塞风险增加没有显着相关性（HR = 3.01; P = 0.286）。

结论：支架置入术可能是治疗AVF部分血栓性动脉瘤和残余血栓的可行方法。尽管通过支架穿刺的瘘管通畅率较低，但这种做法并不伴有较高的阻塞风险。考虑到难以与类似的方法进行比较，需要进一步的研究来确认或驳斥该方法的优点。

启发：支架可作为AVF并发症的解决方案之一，但不宜进行支架穿刺，可能影响长期的通畅率。