中心静脉疾病是维持性血液透析患者血管通路的严重并发症之一,以中心静脉狭窄或闭塞(Central venous stenosis/occlusion, CVS/O)为主要病理表现。CVS/O可通过引发静脉高压综合征破坏血管通路完整性,显著降低透析充分性并缩短患者总体...中心静脉疾病是维持性血液透析患者血管通路的严重并发症之一,以中心静脉狭窄或闭塞(Central venous stenosis/occlusion, CVS/O)为主要病理表现。CVS/O可通过引发静脉高压综合征破坏血管通路完整性,显著降低透析充分性并缩短患者总体透析龄。目前,以经皮腔内血管成形术(Percutaneous transluminal angioplasty, PTA)及支架置入术(Stent placement)为核心的血管内介入治疗已成为临床一线治疗方案。尽管腔内治疗能有效恢复短期静脉通畅性并改善通路功能,但术后再狭窄问题仍严重影响远期疗效。本文系统综述CVS/O腔内治疗的技术进展与循证证据,探讨现存挑战及未来研究方向。Central venous disease, manifesting as stenosis or occlusion (CVS/O), represents a critical complication of vascular access in hemodialysis patients. CVS/O can induce severe venous hypertension, compromise vascular access integrity, reduce dialysis adequacy, and shorten overall dialysis vintage. Endovascular interventions, including percutaneous transluminal angioplasty (PTA) and stent placement, are currently first-line therapies. While these minimally invasive approaches effectively restore short-term venous patency and improve access functionality, the persistent challenge of restenosis significantly compromises long-term outcomes. This review synthesizes recent technological advancements and evidence-based practices in endovascular management of CVS/O, while addressing current limitations and future directions.展开更多
文摘中心静脉疾病是维持性血液透析患者血管通路的严重并发症之一,以中心静脉狭窄或闭塞(Central venous stenosis/occlusion, CVS/O)为主要病理表现。CVS/O可通过引发静脉高压综合征破坏血管通路完整性,显著降低透析充分性并缩短患者总体透析龄。目前,以经皮腔内血管成形术(Percutaneous transluminal angioplasty, PTA)及支架置入术(Stent placement)为核心的血管内介入治疗已成为临床一线治疗方案。尽管腔内治疗能有效恢复短期静脉通畅性并改善通路功能,但术后再狭窄问题仍严重影响远期疗效。本文系统综述CVS/O腔内治疗的技术进展与循证证据,探讨现存挑战及未来研究方向。Central venous disease, manifesting as stenosis or occlusion (CVS/O), represents a critical complication of vascular access in hemodialysis patients. CVS/O can induce severe venous hypertension, compromise vascular access integrity, reduce dialysis adequacy, and shorten overall dialysis vintage. Endovascular interventions, including percutaneous transluminal angioplasty (PTA) and stent placement, are currently first-line therapies. While these minimally invasive approaches effectively restore short-term venous patency and improve access functionality, the persistent challenge of restenosis significantly compromises long-term outcomes. This review synthesizes recent technological advancements and evidence-based practices in endovascular management of CVS/O, while addressing current limitations and future directions.
