目的 探讨支架在人工血管内瘘(arteriovenous graft，AVG)回流静脉应用的长期效果。 方法 选择重庆医科大学附属第一医院金山血管通路中心2016年1月～2021年12月在AVG回流静脉置入支架的患者，收集一般资料及手术信息、随访手术后通畅情况并分析影响因素。 结果 共纳入71例患者，置入支架在AVG建立后(732.15±428.29)天，置入支架前平均干预(4.17±2.52)次。置入支架原因：59.15%为经皮腔内血管成形术后3月内复发性狭窄。手术后6、12、24、36个月初级通畅率分别为84.51%、63.38%、39.62%、24.14%，对应的次级通畅率分别为100%、98.59%、98.04%，89.66%。支架置入术后第1年、第2年、第3年平均再干预次数分别为0.46次、0.83次、1.31次。再干预中位时间为手术后9.80(0.33～41.53)月(以随访期内发生再干预事件患者计算)，30例患者出现支架内边缘狭窄，18例患者出现支架两端新发狭窄。2例患者未发现明显狭窄但因其他原因导致AVG血栓。 结论 支架置入是处理AVG回流静脉狭窄的有效手段，但AVG通畅率影响因素多，支架本身也可能诱发新的狭窄，是否置入支架仍需临床医生根据实际情况个体化判断。
Objective To investigate the long-term prognosis of stent implantation for arteriovenous graft (AVG) outflow stenosis. Methods Patients with AVG outflow stenosis and received stent implantation from January 2016 to December 2021 in Jinshan Hemodialysis Access Center, the First Affiliated Hospital of Chongqing Medical University were enrolled in this study. General information were collected, postoperative patency was followed up, and the influence factors for postoperative patency were analyzed. Results A total of 71 patients were included with (732.15±428.29) days after AVG creation and (4.17±2.52) times of percutaneous transluminal angioplasty (PTA) before stent implantation. Stent implantation was performed for recurrent stenosis within 3 months after PTA in 59.15% of the patients. The primary patency rates were 84.51%, 63.38%, 39.62% and 24.14%, and the secondary patency rates were 100%, 98.59%, 98.04% and 89.66% after stent implantation for 6 months, 12 months, 24 months and 36 months, respectively. The mean re-intervention times after the first stenting were 0.46, 0.83 and 1.31 times in the first year, second year and third year, respectively. The median re-intervention time was 9.80 months after stenting (0.33～41.53 months, calculated only the cases with re-intervention events during follow-up). Thirty cases developed in-stent edge stenosis, 18 cases developed de novo stenosis at two ends of stent, and 2 cases had AVG thrombosis without stenosis and probably caused by other factors. Conclusion Stent implantation is an effective management for AVG outflow stenosis. There are many factors affecting AVG patency, and new stenosis lesions may be induced by stenting itself. Therefore, stenting operation needs to be judged individually.
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