Clinical outcomes and predictive factors of stent grafts treatment for symptomatic central venous obstruction in end stage kidney disease patients with arteriovenous access

Clinical outcomes and predictive factors of stent grafts treatment for symptomatic central venous obstruction in end stage kidney disease patients with arteriovenous access | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Clinical outcomes and predictive factors of stent grafts treatment for symptomatic central venous obstruction in end stage kidney disease patients with arteriovenous access yamin liu, yufei wang, xinfang wang, beihao zhang, xiaoqing lu, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3916835/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Aim To assess the effectiveness and predictive factors of stent grafts (SGs) for the treatment of central venous obstruction disease (CVOD) in hemodialysis (HD) patients with arteriovenous (AV) access. Methods HD patients with CVOD who underwent SGs at our center between August 2018 and June 2022 were enrolled. The Kaplan–Meier method and log-rank test were used for survival curve analysis. SGs. Results 59 SG implantation procedures for CVOD were analyzed using Cox proportional hazards regression for the predictive factor analysis. Thirty subjects had stenosis and 29 had occlusion. The access circuit primary patency (ACPP) after SG placement at 6, 12, and 24 months was 80.9%, 53.8%, and 31.4%, respectively. The target lesion primary patency (TLPP) after SG placement at 6, 12, and 24 months were 91.3%, 67.6%, and 44.5%, respectively. I n the subgroup analysis, the TLPP was higher in the stenosis group than in the occlusion group, but the difference was not significant ( P = 0.165). The TLPP of procedures post-SG placement was significantly improved compared to th at before SG placement ( P < 0.001). Cox proportional hazards regression showed that a target lesion length ≥ 30 mm and procedural defects were independently associated with a lower TLPP after SG treatment for CVOD in HD patients. Conclusion SG placement is safe and effective for t he treat ment of CVOD in HD patients . SG improves the TLPP of endovascular therapy (EVT) for CVOD. A target lesion length ≥ 30 mm and procedure defects were predictive factors for TLPP. Health sciences/Nephrology Health sciences/Risk factors Figures Figure 1 Figure 2 Introduction Central venous obstruction disease (CVOD) is a pathological condition in which stenosis or occlusion occurs in the central vein. The prevalence of CVOD ranges from 5% to as high as 50% and has been reported in patients with end -stage kidney disease (ESKD) undergoing hemodialysis(HD) [ 1 – 3 ] . CVOD is common but always asymptomatic in patients with ESKD without arteriovenous (AV) access , that is, arteriovenous fistula (AVF) or arteriovenous graft (AVG). However, in ESKD patients with AV access, because a large blood flow volume eventually returns to the central veins, CVOD often manifests as ipsilateral upper extremity or breast edema, varicosity, venous hypertension, or prolonged bleeding [ 4 ] . Endovascular therapy (EVT) is recommended as the primary treatment for symptomatic CVOD [ 4 ] . Recent studies have demonstrated that stent grafts (SGs) h ave superior long-term patency of CVOD over percutaneous transluminal angioplasty (PTA) or bare stents [ 5 – 7 ] . However, the target lesion primary patency (TLPP) of SGs for CVOD treatment differs significantly among patients. Thus, it is important to identify factors associated with TLPP after SG placement. However, few studies have examined the predictive factors of primary patency after SGs placement to treat CVOD in ESKD patients [ 8 , 9 ] . In this study, we retrospectively reviewed the data of ESKD patients with symptomatic CVOD treated with SGs in our center to identify the predictors of higher primary patency. Results Characteristics of patients and lesions at the time of SGs placement During the study period, 54 hemodialysis patients underwent 59 SG implantation procedures for CVOD. The baseline patient characteristics, lesion characteristics, and procedural parameters are reported in Table 1 . The mean age of the subjects was 59.3 ± 1.6 years. 36 (61.0%) subjects were male, and 43 (72.9%) had diabet es mellitus. 35 (59.3%) patients had a history of ipsilateral CVC insertion, and the interval of catheter indwelling was 2 (0, 10) months. Arm swelling was the main manifestation of CVOD. Most lesions (57.6%) were in the BCV, and eight (13.6%) were in the SVC. The mean interval between access creation and SG placement was 30.6 (17.3, 47.9) . 38 (64.4%) patients underwent at least one PTA intervention prior to SG placement. Indication s for SG placement were total occlusion (49.2%) and stenosis (50.8%). The outflow of the AVF or venous limb of the AVG was the approach for most procedures ; however, the femoral vein or other approaches were needed in 10 procedures. Table 1 The baseline characteristics at the time of stent graft implantation Variable No.=59, Mean ± SD or median (range) % Sex, male 36 61.0 Age, year 59.3 ± 1.6 Diabetes mellitus 43 72.9 AV access type AVF 47 79.7 AVG 12 20.3 Location of AV access Left upper extremity 38 64.4 Right upper extremity 21 35.6 History of ipsilateral CVC insertion, percentage 35 59.3 Interval of ipsilateral CVC indwelling, months 2(0, 10) Length of target lesion(mm) 30(20, 60) Symptoms Swelling of head、face and neck Swelling of arm Swelling of breast High venous pressure 12 45 2 19 20.3 76.3 3.4 32.2 Location of target lesion Superior vena cava Brachiocephalic vein Subclavian vein 8 34 17 13.6 57.6 28.8 Across costoclavicular joint Yes No 34 25 57.6 42.4 Defects of procedure No Yes Poor distal runoff Incomplete coverage of target lesion 46 13 9 6 78.0 22.0 - - Branch covered by SG No Internal jugular vein Contralateral brachiocephalic vein Others 15 35 4 5 25.4 59.3 6.8 8.5 Target lesion Stenosis Occlusion 30 29 50.8 49.2 Blood flow pre-SG, ml/min 925(780, 1200) Comparison between the two groups, P = 0.083 Blood flow post-SG, ml/min 1000(870, 1230) Types of SG 61 Viabahn 43 71.7 Excluder 15(1) 26.7 Fluency Plus 1(1) 3.3 Diameter of SG, mm 13(11, 13) Length of SG, mm 70(50, 100) Pre-dilated balloon diameter, mm 12(10, 14) Post-dilated balloon diameter, mm 12(10, 14) Stent diameter/adjacent distal vessel diameter ratio 1 14 12 33 23.7 20.3 55.9 Approaches Fistula only Fistula + femoral vein Fistula + femoral vein + jugular vein Internal jugular vein only 49 7 2 1 83.0 11.9 3.4 1.7 Multiple approach imaging for stent positioning Yes No 35 24 59.3 40.7 Procedure duration, minute 55(40, 70) Times of endovascular treatment prior SG 0 1 2 ≥ 3 21 19 6 13 35.6 32.2 10.2 22.0 Sharp recanalization Yes No 6 53 10.2 89.8 Complication 2 3.4 Abbreviation: AV, arteriovenous; AVF, arteriovenous fistula; AVG, arteriovenous graft;CVC, central venous catheter; SG, stent graft; 2 subjects had poor runoff and incomplete coverage of the lesion. SGs were selected to match the diameters of adjacent veins and cover the entire target lesion (Supplement ary Table S1 ). Procedural success was achieved in all patients, with 2(3.4%) major complications. One patient had severe ly poor distal runoff and incomp lete coverage of the target lesion after the first SG implantation and underwent a second SG during the procedure. T he other patient with superior vena cava occlusion underwent sharp recanalization, but the guidewire entered the extravascular space and re -enter ed the true lumen during sharp recanalization [ 13 ] , and two SGs were needed to cover all the target lesion s. Stent migration and vascular rupture were not observed in this study. The clinical success rate was 100%, with resolution of the presenting symptoms in all the patients. Nine SGs were judged as having poor distal runoff and six SGs were judged as having incomplete coverage ; eventually, 13 SGs had defects in the procedure . Patency after SGs placement The median follow-up period was 23.6 ± 11.8 months. Six patients died and no patient was lost to follow-up during the study period. The ACPP after SG placement at 6, 12, and 24 months were 80.9%, 53.8%, and 31.4%, respectively. The median time of ACPP after SG placements was 15.2(95%CI, 8.3–22.1) months. TLPP after SG placement at 6, 12, and 24 months was 91.3%, 67.6%, and 44.5%, respectively . The median time of TLPP after SG placements was 21.5 (95%CI, 15.8,27.1) months (Fig. 1 A and Table 2 ). Table 2 Kaplan–Meier curve of stent grafts (SGs). 6 months 12 months 24 months 36 months TLPP (%) 91.3 67.6 44.5 37.0 ACPP (%) 80.9 53.8 31.4 24.7 Abbreviation: ACPP, access circuit primary patency; TLPP, target lesion primary patency. TLPP of SGs in different location s , that is, SCV, BCV, and SVC, was compared, and there was no significant difference among the three groups ( P = 0.830) (Fig. 1 B). Subjects were divided into two groups according to whether the target lesions were stenos is (n = 30) or occlusion s (n = 29) to compare TLPP after SG implantation. The TLPP was higher in the stenosis group than in the occlusion group, but the difference was not significant ( P = 0.165) (Fig. 1 C). TLPP was improved by SGs TLPP before and after SG implantation was compared in a subgroup of 38 patients who had at least one PTA prior to SG placement . The median intervention time post-SG implantation was significantly higher than that after proximate PTA pre-SG implantation [15.8 (9.6, 23.8) vs. 3.8(2.2, 7) months, P < 0.001]. The median intervention time of every EVT post-SG implantation was also higher than that pre-SG implantation [10.0 (5.9, 23.2) vs. 3.8 (2.4, 6.3) months, P < 0.001] (Fig. 2 ). Predictive outcome factors of SGs Cox proportional hazards analysis was used to investigate the impact of preoperative and perioperative factors on TLPP. Multivariate analysis revealed that a target lesion length of ≥ 30 mm and defects in the procedure were independent predictor s of target lesion failure ( Table 3 ). Table 3 Univariate and multivariate Cox proportional hazards regression analyses of TLPP Variable Univariate model Multivariate model a Multivariate model b Multivariate model c HR(95%CI) P HR(95%CI) P HR(95%CI) P HR(95%CI) P Sex(Female/Male) 0.880(0.406–1.906) 0.745 Age(≥57/<57years) 0.726(0.340–1.552) 0.409 Diabetes mellitus (Yes/No) 0.842(0.368–1.930) 0.685 AV access type(AVG/AVF) 2.850(1.206–6.736) 0.017 1.842(0.632–5.371) 0.263 1.846(0.601–5.666) 0.284 1.310(0.394–4.362) 0.659 Location of AV access(Right/Left upper extremity) 0.732(0.328–1.635) 0.446 History of ipsilateral CVC insertion, months(Yes/No) 1.206(0.552–2.638) 0.638 Target lesion length(≥30/<30mm) 3.741(1.663–8.412) 0.001 4.558(1.545–13.448) 0.006 4.578(1.268–16.526) 0.020 5.914(1.525–22.937) 0.010 Location of target lesion superior vena cava brachiocephalic vein subclavian vein 1 1.604(0.370–6.960) 1.129(0.233–5.475) 0.645 0.528 0.880 Across costoclavicular joint(No/Yes) 3.058(1.416–6.608) 0.004 1.625(0.580–4.553) 0.355 1.623(0.563–4.678) 0.370 2.284(0.706–7.388) 0.168 Defects of procedure(Yes/No) 11.822(4.860-28.757) <0.001 14.020(3.687–53.317) <0.001 14.022(3.678–53.324) <0.001 13.960(3.571–54.573) <0.001 Stent diameter/adjacent distal vessel diameter ratio (≥ 1/<1) 4.036(0.954–17.075) 0.058 2.350(0.511–10.814) 0.273 2.349(0.510-10.815) 0.273 2.175(0.458–10.320) 0.328 Length of SG (≥ 100/<100mm) 1.733(0.802–3.745) 0.162 0.993(0.307–3.208) 0.990 1.082(0.322–3.635) 0.899 Branch covered by SG (Yes/No) 0.929(0.374–2.307) 0.873 Multiple approach imaging for stent positioning(Yes/No) 0.700(0.313–1.562) 0.383 Target lesion type (Occlusion/Stenosis) 1.704(0.796–3.648) 0.170 1.769(0.760–4.120) 0.186 1.769(0.758–4.127) 0.187 1.295(0.499–3.361) 0.595 Blood flow post-SG(≥1000/<1000ml/min) 0.790(0.365–1.709) 0.549 Approach(Other route/Fistula only) 1.566(0.652–3.763) 0.316 EVT prior SG(Yes/No) 0.936(0.409–2.142) 0.875 Sharp canalization(Yes/No) 1.687(0.637–4.468) 0.292 3.382(0.900-12.704) 0.071 Abbreviation: AV, arteriovenous; AVF, arteriovenous fistula; AVG, arteriovenous graft;CI, Confidenc interval༛CVC, central venous catheter; EVT, endovascular treatment; HR, Hazard ratio; SG, stent graft; TLPP, target lesion primary patency; The cut-off of age and procedure time were median values. Model a , Variables with a value of p < 0.1 in the univariate analysis were input into the multivariate Cox regression analysis. Model b , Variables with a value of p < 0.2 in the univariate analysis were input into the multivariate Cox regression analysis. Model c , Variables with a value of p < 0.3 in the univariate analysis were input into the multivariate Cox regression analysis. Discussion CVOD has become a common problem for vascular access specialist s as the dialysis population continue s to increase, and the use of CVC has increase d. The guidelines [ 4 , 11 ] recommend that asymptomatic CVOD do not need to be treated. For symptomatic CVOD, treatment includes surgery (such as surgical bypass or medial claviculectomy) and EVT. EVT, which is less invasive than surgical bypass, with comparable short-term patency , is the preferred intervention [ 14 – 17 ] . However, EVT also has disadvantages, such as elastic recoil and restenosis after PTA, which seriously affect the quality of life of patients and increases medical expenses [ 5 , 18 , 19 ] . More recent studies have shown superiority of SGs over both PTA and bare-metal stents in terms of long-term patency [ 5 , 20 – 22 ] . In this study, we analyzed the patency of 59 SG implantation procedures for CVOD. The ACPP rates at 6, 12, and 24 months post-SG placement were 80.9%, 53.8%, and 31.4%, respectively. The TLPP at 6, 12, and 24 months post-SG placement was 91.3%, 67.6%, and 44.5%, respectively . A previous cohort study that included 60 cases with Excluder SGs for CVOD found that ACPP was 54.9% and TLPP was 88.3% at 12 months [ 23 ] . Another study showed that TLPP and ACPP with SGs for CVOD at 12 months were 56% and 29% [ 21 ] . In a study of 30 patients treated with Viabahn SGs for CVOD, TLPP was 97%, 81%, 67%, and 45% at 3, 6, 12, and 24 months, respectively [ 6 ] . The results of our study were generally consistent with those reported in the literature, which may be related to factors such as single-center studies, stricter indications, and greater consistency in the surgical procedures. In subgroup analysis, TLPP with SG in the stenosis group was superior to that in the occlusive group, although the difference was not statistically significant. This suggests that lesions should be identified early and treated at the stenotic stage, rather than evolving to occlusion. Jones et al. [ 6 ] reported results similar to ours, which showed that p atients with occlusive lesions had a significantly shorter primary patency interval ( P = 0 .05) than those with stenosis. Occluded veins were more likely to require SGs ( P = 0.02). From another perspective, the procedures spent more time in the occlusive group than in the stenosis group [65(45,107.5) vs.45(38,60) min , P = 0.002]. Our study also found that SG use improved the intervention interval and reduced the number of interventions in patients who had previously undergone PTA. Jones et al. indic ated that SG placement to treat CVOD in HD patients was safe and effective if PTA failed to maintain luminal patency [ 6 ] . Gong et al. concluded that SG placement to salvage central vein stenosis stents with recalcitrant restenosis in patients with AV fistulas is safe and effective if PTA failed [ 24 ] . Our results were consistent with Vachharajani et al.’ s viewpoint that SG implantation seems to benefit the TLPP and has been shown to reduce the number of interventions needed to maintain access patency [ 25 ] . Our study found that a target lesion length ≥ 30 mm was a predictive factor, whereas stent length was not. Previous studies have suggested stent length as a predictive factor [ 9 ] , but our study, which was much more numerous, did not find it to be statistically significant. Theoretically, the longer the target lesion, the longer the stent length. In fact, because of the accessibility of the stents, six did not completely cover the lesion, and most of the stent lengths we used were the three specifications: 5 cm (19 grafts) , 7 cm (14 grafts), and 10 cm (21 grafts). The selection of stent length should consider not only the length of the target lesion, but also whether the stent has good runoff after release. Our results also showed that procedural defects were predictive factor s . For good distal runoff grafts, the runoff of the SG s and the vessel are consistent without serious angulation, which could reduce the blood flow disorder of marginal SGs, thus reducing the probability of distal edge stenosis of the SGs. Another reason is that SGs did not completely cover the lesion, which means intimal hyperplasia of the target lesion will continue to cause stenosis, which would be aggravated by the disordered blood flow of the stent edge [ 21 ] . We found, for the first time, that the blood flow of AV access was not statistically significant for TLPP. High blood flow could stimulate intimal hyperplasia and accelerate stent marginal stenosis [ 26 ] , but most of the included patients were not high-flow patients, and the median blood flow was 1000 ml/min. Patients with high-flow AV access and central venous lesions are not indicated for stents. Compared with same-sized/oversized stents for central venous lesions, undersized stents did not show an advantage for TLPP. We should declare that the undersized stent diameter was compared to the distal marginal vessels, which was different from the AVG outflow tract stent [ 27 ] . Gilbert et al. evaluated the effect of a WRAPSODYTM Cell-impermeable Endoprosthesis in treating AV access circuit stenosis. In this study, devices were deployed in a 10–25% oversized configuration (vs. adjacent healthy vessel) with at least 1 cm overlap with a healthy vessel or synthetic graft. Eleven devices were placed in the central vein and the 12-month TLPP was 100% [ 28 ] . A recent study proposed that undersized stent s ha ve better primary patency [ 29 ] . Our results showed that undersized stent s had no advantage over same-sized/oversized stents , probably because the assessment of the central venous diameter was not accurate and could be influenced by respiration and balloon dilation. Another reason may be the small sample size. The present study has some limitations. First, this was a retrospective study conducted at a single center, which would affect the reproducibility of the results. Second, the present study had a short follow-up duration. T hus, more prospective randomized controlled trials should be performed to evaluate the effectiveness and safety of SG treatment in the future. Method Study design and patient population This study was conducted by retrospectively analyzing prospectively collected data involving a cohort of patients who rece ived SGs for CVOD treatment between August 2018 and June 2022 at the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China. CVOD was defined as symptomatic vascular stenosis or obstruction by a lesion located in the central venous system consisting of the subclavian vein (SCV), brachiocephalic vein (BCV), and superior vena cava (SVC); however, the internal jugular vein was excluded. The indications for SG placement include occlusive lesions, acute elastic recoil > 30% after PTA, and restenosis within 3 months of balloon angioplasty for the same lesion. Fifty-nine SG placement procedures were performed in 54 patients and 61 SGs were implanted in the cohort. Follow-up ended on D ecember 31, 2022, with access abandonment, patient death, or loss to follow-up. This study has been performed in accordance with the Declaration of Helsinki and was approved by the Human Research Ethics Committee of the First Affiliated Hospital of Zhengzhou University. Informed consent was obtained from all patients prior to the procedure. Procedures All procedures were performed under local anesthesia. Digital subtraction angiography (DSA) was conducted before all EVT procedures to evaluate the lesions, and some were combined with computed tomography angiography (CTA). Viabahn™ (W. L. Gore & Associates Inc., CA, USA), Fluency TM Plus (Bard Peripheral Vascular, Tempe, Arizona, USA), or Excluder ™ AAA contralateral leg (W. L. Gore & Associates Inc., CA, USA) SGs, with a diameter matching the adjacent vessel and length covering the entire target lesion, were selected based on the physician’s judgement. The treatment was performed at a single center by a well-trained interventional nephrologist. The first choice of approach is AVF outflow or the venous limb of the AVG. However, the femoral vein or other approaches are needed in some cases. Unfractionated heparin (1000–5000 IU) was injected into the sheath to prevent clotting. We often used 0.035 inch guidewire cooperated with a single curved catheter or a long sheath to cross the severe stenosis lesion, known as the blunt recanalization technique. For the total occlusive lesion, we often used a sharp recanalization technique [ 10 ] . SGs was performed after angioplasty using a noncompliant balloon. All SGs were dilated using the balloon size used in the initial angioplasty procedure. Procedure duration was defined as the interval between the start of percutaneous puncture and the remov al of vascular sheaths. Procedures were judged by two other operators to evaluate poor runoff or incomplete coverage of the lesion. Rivaroxaban (10– 20 mg/day) was prescribed without any contraindications within the first month after SG placement. Follow-up All patients underwent regular hemodialysis. Clinic al or telephone surveillance was performed quarterly during the follow-up period. Symptoms related to superior vena cava syndrome were the key points of routine surveillance, and venography were recommended when patients were suspected to have significant restenosis. EVT was performed according to the indications recommended by the KDOQI Vascular Access guidelines [ 4 ] . Definition Clinical success was defined as the ability to complete at least one HD session after SG placement. Patency was defined according to the Committee on Reporting Standards for Arteriovenous Access by the Society for Vascular Surgery and the American Association for Vascular Surgery. Target lesion primary patency (TLPP) was defined as the interval from any EVT until reintervention in the target lesions. Access Circuit Primary Patency (ACPP) after SG refers to the interval from SG placement until reintervention in the access circuit [ 11 , 12 ] . Major complications were defined as those that required additional treatment. Statistical analysis SPSS 23.0 and Prism 9.0, were applied for statistical processing, and the measurement data were expressed as mean and standard deviation, and the count data were expressed as the number of cases and percentages, which were tested for normality using the Kolmogorov-Smi rnov method. When comparing two groups of measurement data, t-test was used for normal data and the non-parametric test was used for non-normal data. The Kaplan–Meier method and log-rank test were used for survival curve analysis. Cox proportional hazards regression was used for predictive factor analysis of SG patency . Statistical significance was set at P < 0.05. Conclusion In conclusion, SG placement to treat CVOD in HD patients is safe and effective, and could improve TLPP in patients who have previously undergone PTA. A target Lesion length ≥ 30 mm and defects in the procedure are predictors of TLPP. Declarations Conflict of Interest Statement The authors have no conflicts of interest to declare. Author Contribution Conception and design: YML, XHL, PW; Analysis and interpretation: YFW, YML, PW; Data collection: YML, BHZ, XFW, XHL; Writing the article: YML, XFW, XQL，PW; Final approval of the article: YFW, XQL, PW; Statistical analysis: YFW, YML; Overall responsibility: PW Acknowledgements The authors thank all the patients and researchers who participated in this study. The authors are also thankful to the medical team of Blood Purification Center of the First Affiliated Hospital of Zhengzhou University for their assistance and support. 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The impact of stent-graft sizing on venous stenosis re-intervention and arteriovenous graft patency: Free-floating stent outflow is associated with improved outcomes [J]. J Vasc Access, 2022: 11297298221137152. GILBERT J, RAI J, KINGSMORE D, et al. First Clinical Results of the Merit WRAPSODY Cell-Impermeable Endoprosthesis for Treatment of Access Circuit Stenosis in Haemodialysis Patients [J]. Cardiovasc Intervent Radiol, 2021, 44(12): 1903–13. HUANG E P, LI M F, HSIAO C C, et al. Undersized stent graft for treatment of cephalic arch stenosis in arteriovenous hemodialysis access [J]. Sci Rep, 2020, 10(1): 12501. Additional Declarations No competing interests reported. Supplementary Files SupplementTableS1.pdf Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 01 Apr, 2024 Reviews received at journal 17 Mar, 2024 Reviewers agreed at journal 13 Mar, 2024 Reviewers invited by journal 12 Mar, 2024 Editor assigned by journal 06 Mar, 2024 Editor invited by journal 17 Feb, 2024 Submission checks completed at journal 17 Feb, 2024 First submitted to journal 01 Feb, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3916835","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":273372301,"identity":"1703f77b-a5cb-46b4-807b-10092058778b","order_by":0,"name":"yamin liu","email":"","orcid":"","institution":"First Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"prefix":"","firstName":"yamin","middleName":"","lastName":"liu","suffix":""},{"id":273372302,"identity":"1eae055c-e34e-4f7d-ad36-fd49f6084ab9","order_by":1,"name":"yufei wang","email":"","orcid":"","institution":"First Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"prefix":"","firstName":"yufei","middleName":"","lastName":"wang","suffix":""},{"id":273372303,"identity":"0773c2ce-e9d9-4c04-b27b-ffa608289d46","order_by":2,"name":"xinfang wang","email":"","orcid":"","institution":"First Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"prefix":"","firstName":"xinfang","middleName":"","lastName":"wang","suffix":""},{"id":273372304,"identity":"0a61bd0f-0232-4c76-8dcf-89c2861aa687","order_by":3,"name":"beihao zhang","email":"","orcid":"","institution":"First Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"prefix":"","firstName":"beihao","middleName":"","lastName":"zhang","suffix":""},{"id":273372305,"identity":"7292262e-ec92-47af-a601-891f0d8617e2","order_by":4,"name":"xiaoqing lu","email":"","orcid":"","institution":"First Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"prefix":"","firstName":"xiaoqing","middleName":"","lastName":"lu","suffix":""},{"id":273372306,"identity":"1bcfbbb7-d5b1-4835-99a0-11bfecaa7905","order_by":5,"name":"xianhui liang","email":"","orcid":"","institution":"First Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"prefix":"","firstName":"xianhui","middleName":"","lastName":"liang","suffix":""},{"id":273372307,"identity":"70de6cca-f52d-47cb-af22-f19df8827d43","order_by":6,"name":"pei wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAr0lEQVRIiWNgGAWjYJCCAx8gtAHxWg7OIFkLMw9JWgxuNx88bPOnLrGBvXmbBEPNHSK03DmWcDiHhy2xgedYmQTDsWeEtZjdyDE4nCPBk9ggkWMmwdhwmBgt+R8OWxhIJDbIvyFaSw7DYYYEA6AtPERqsb9zzOBgz4EE4zaetGKLhGNEaJGc3fz4w48/dbL97Ic33vhQQ4QWBgkozQYiEojQgNAyCkbBKBgFowAnAABBxTllVm/8GwAAAABJRU5ErkJggg==","orcid":"","institution":"First Affiliated Hospital of Zhengzhou University","correspondingAuthor":true,"prefix":"","firstName":"pei","middleName":"","lastName":"wang","suffix":""}],"badges":[],"createdAt":"2024-02-01 09:29:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3916835/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3916835/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":51390368,"identity":"00d5880a-60e6-4d76-80af-0e04e8bdace4","added_by":"auto","created_at":"2024-02-20 18:19:59","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1788420,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eKaplan–Meier curve of stent grafts (SGs).\u003c/strong\u003e A：Kaplan–Meier curves of target lesion primary patency (TLPP), access circuit primary patency(ACPP). B: TLPP (superior vena cava VS. brachiocephalic vein VS. subclavian vein, P=0.830). C: TLPP (stenosis VS. occlusion, P=0.165).\u003c/p\u003e","description":"","filename":"fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-3916835/v1/198949480c1f94b73d2d0b78.png"},{"id":51390369,"identity":"26c5b8e4-0e79-4469-943c-a92b16a4ca5a","added_by":"auto","created_at":"2024-02-20 18:19:59","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1708040,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eImprovement of target lesion primary patency (TLPP) post-SG placement. \u003c/strong\u003eAmong the 38 patients who had at least onepercutaneous transluminal angioplasty (PTA) intervention prior SG placement, TLPP was significantly improved. A: TLPP post-SG placement compared to proximate PTA pre-SG (P \u0026lt; 0.001); B: Median intervention time post-SG is longer than the proximate PTA pre-SG [15.8 (9.6，23.8)VS. 3.8(2.2，7)months, P\u0026lt;0.001]; C: TLPP was significantly improved after each intervention post-SG compared with pre-SG (P\u0026lt;0.001), D: Median of each intervention time were 4.8 (2.5, 13.1) months of pre-SG and 10 (5.9, 23.2) months of post-SG (P\u0026lt;0.001) .\u003c/p\u003e","description":"","filename":"fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-3916835/v1/e7ae5e3e90f684571f97e8df.png"},{"id":51391697,"identity":"9f8265ba-8de2-40ae-b329-5d23f2f85d38","added_by":"auto","created_at":"2024-02-20 18:28:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":584831,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3916835/v1/fd90437d-594e-4f02-8610-1a1e4a02a674.pdf"},{"id":51390370,"identity":"334fda20-b957-4ad9-a1bc-5b67106594f3","added_by":"auto","created_at":"2024-02-20 18:20:00","extension":"pdf","order_by":7,"title":"","display":"","copyAsset":false,"role":"supplement","size":109175,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementTableS1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3916835/v1/50d84de428a1b4c542925c7a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical outcomes and predictive factors of stent grafts treatment for symptomatic central venous obstruction in end stage kidney disease patients with arteriovenous access","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCentral venous obstruction disease (CVOD) is a pathological condition in which stenosis or occlusion occurs in the central vein. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe\u003c/span\u003e prevalence of CVOD ranges from 5% to as high as 50% \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eand has been reported in patients with end\u003c/span\u003e-stage kidney disease (ESKD) undergoing hemodialysis(HD)\u003csup\u003e[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. CVOD is common but always asymptomatic in patients \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ewith ESKD without arteriovenous (AV) access\u003c/span\u003e, that is, arteriovenous fistula (AVF) or arteriovenous graft (AVG). However, in ESKD patients with AV access, because \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ea large blood flow volume eventually returns to the central veins, CVOD often manifests as ipsilateral upper extremity or breast edema, varicosity, venous hypertension, or prolonged bleeding\u003c/span\u003e\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eEndovascular therapy (EVT) is recommended as the primary treatment for symptomatic CVOD\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Recent studies \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ehave demonstrated that stent grafts (SGs) h\u003c/span\u003eave superior long-term patency of CVOD over percutaneous transluminal angioplasty (PTA) or bare stents\u003csup\u003e[\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. However, the target lesion primary patency (TLPP) of SGs for CVOD treatment differs significantly among patients. Thus, it is important to identify factors associated with TLPP after SG placement. However, few studies have examined \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe predictive factors\u003c/span\u003e of primary patency after SGs placement to treat CVOD in ESKD patients\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. In this study, we retrospectively reviewed the data of ESKD patients with symptomatic CVOD treated with SGs in our center to identify \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe predictors of higher primary patency.\u003c/span\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of patients and lesions at the time of SGs placement\u003c/h2\u003e \u003cp\u003eDuring the study period, 54 hemodialysis patients underwent 59 SG implantation procedures for CVOD. The baseline patient characteristics, lesion characteristics, and procedural parameters are reported in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The mean age of the subjects was 59.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6 years. 36 (61.0%) subjects were male, \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eand 43 (72.9%) had diabet\u003c/span\u003ees mellitus. 35 (59.3%) patients had a history of ipsilateral CVC insertion, \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eand the interval of catheter indwelling was\u003c/span\u003e 2 (0, 10) months. Arm \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eswelling was the main manifestation of CVOD. Most lesions (57.6%) were in the BCV, and\u003c/span\u003e eight (13.6%) were in \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe SVC. The mean interval between access creation and SG placement was 30.6 (17.3, 47.9)\u003c/span\u003e. 38 (64.4%) patients underwent at least one PTA intervention prior to SG placement. Indication\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003es for SG placement\u003c/span\u003e were total occlusion (49.2%) and stenosis (50.8%). \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe\u003c/span\u003e outflow of \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe AVF or venous limb of the AVG was the approach for most procedures\u003c/span\u003e; however, \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe femoral vein\u003c/span\u003e or other approaches were needed in 10 procedures.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe baseline characteristics at the time of stent graft implantation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo.=59, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or median (range)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, male\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAV access type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAVF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAVG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation of AV access\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft upper extremity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight upper extremity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of ipsilateral CVC insertion, percentage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterval of ipsilateral CVC indwelling, months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(0, 10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of target lesion(mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30(20, 60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSymptoms\u003c/p\u003e \u003cp\u003eSwelling of head、face and neck\u003c/p\u003e \u003cp\u003eSwelling of arm\u003c/p\u003e \u003cp\u003eSwelling of breast\u003c/p\u003e \u003cp\u003eHigh venous pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003cp\u003e45\u003c/p\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.3\u003c/p\u003e \u003cp\u003e76.3\u003c/p\u003e \u003cp\u003e3.4\u003c/p\u003e \u003cp\u003e32.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation of target lesion\u003c/p\u003e \u003cp\u003eSuperior vena cava\u003c/p\u003e \u003cp\u003eBrachiocephalic vein\u003c/p\u003e \u003cp\u003eSubclavian vein\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003cp\u003e34\u003c/p\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.6\u003c/p\u003e \u003cp\u003e57.6\u003c/p\u003e \u003cp\u003e28.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcross costoclavicular joint\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.6\u003c/p\u003e \u003cp\u003e42.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDefects of procedure\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003ePoor distal runoff\u003c/p\u003e \u003cp\u003eIncomplete coverage of target lesion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003cp\u003e13\u003c/p\u003e \u003cp\u003e9\u003c/p\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78.0\u003c/p\u003e \u003cp\u003e22.0\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBranch covered by SG\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eInternal jugular vein\u003c/p\u003e \u003cp\u003eContralateral brachiocephalic vein\u003c/p\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003cp\u003e35\u003c/p\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.4\u003c/p\u003e \u003cp\u003e59.3\u003c/p\u003e \u003cp\u003e6.8\u003c/p\u003e \u003cp\u003e8.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTarget lesion\u003c/p\u003e \u003cp\u003eStenosis\u003c/p\u003e \u003cp\u003eOcclusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.8\u003c/p\u003e \u003cp\u003e49.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood flow pre-SG, ml/min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e925(780, 1200)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eComparison between the two groups, P\u0026thinsp;=\u0026thinsp;0.083\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood flow post-SG, ml/min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1000(870, 1230)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTypes of SG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eViabahn\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExcluder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15(1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFluency Plus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiameter of SG, mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13(11, 13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of SG, mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70(50, 100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-dilated balloon diameter, mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12(10, 14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-dilated balloon diameter, mm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12(10, 14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStent diameter/adjacent distal vessel diameter ratio\u003c/p\u003e \u003cp\u003e\u0026lt;1\u003c/p\u003e \u003cp\u003e=1\u003c/p\u003e \u003cp\u003e\u0026gt;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003cp\u003e12\u003c/p\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.7\u003c/p\u003e \u003cp\u003e20.3\u003c/p\u003e \u003cp\u003e55.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApproaches\u003c/p\u003e \u003cp\u003eFistula only\u003c/p\u003e \u003cp\u003eFistula\u0026thinsp;+\u0026thinsp;femoral vein\u003c/p\u003e \u003cp\u003eFistula\u0026thinsp;+\u0026thinsp;femoral vein\u0026thinsp;+\u0026thinsp;jugular vein\u003c/p\u003e \u003cp\u003eInternal jugular vein only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003cp\u003e7\u003c/p\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.0\u003c/p\u003e \u003cp\u003e11.9\u003c/p\u003e \u003cp\u003e3.4\u003c/p\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiple approach imaging for stent positioning\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.3\u003c/p\u003e \u003cp\u003e40.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProcedure duration, minute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55(40, 70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTimes of endovascular treatment prior SG\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e6\u003c/p\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.6\u003c/p\u003e \u003cp\u003e32.2\u003c/p\u003e \u003cp\u003e10.2\u003c/p\u003e \u003cp\u003e22.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSharp recanalization\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.2\u003c/p\u003e \u003cp\u003e89.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eAbbreviation: AV, arteriovenous; AVF, arteriovenous fistula; AVG, arteriovenous graft;CVC, central venous catheter; SG, stent graft; 2 subjects had poor runoff and incomplete coverage of the lesion.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSGs were selected to match the diameters of adjacent veins and cover the entire target lesion (Supplement\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eary Table S1\u003c/span\u003e). Procedural success was achieved in all patients, with 2(3.4%) major complications. One patient had severe\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ely poor distal runoff and incomp\u003c/span\u003elete coverage of the target lesion after the first SG implantation and underwent \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ea second SG during the procedure. T\u003c/span\u003ehe other patient with superior vena cava occlusion underwent sharp recanalization, but the guidewire entered \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe extravascular space\u003c/span\u003e and re\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e-enter\u003c/span\u003eed the true lumen during sharp recanalization\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e, and two SGs were needed to cover all the target lesion\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003es.\u003c/span\u003e Stent migration and vascular rupture were not observed in this study. The clinical success rate was 100%, with resolution of the presenting symptoms in all \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe patients.\u003c/span\u003e Nine SGs were judged as \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ehaving poor distal runoff and\u003c/span\u003e six SGs were judged as \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ehaving incomplete coverage\u003c/span\u003e; eventually, 13 SGs had defects in \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe procedure\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003ePatency after SGs placement\u003c/h2\u003e \u003cp\u003eThe median follow-up period was 23.6\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8 months. Six patients died and no patient \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ewas\u003c/span\u003e lost to follow-up during the study period. The ACPP \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eafter\u003c/span\u003e SG placement at 6, 12, and 24 months were 80.9%, 53.8%, and 31.4%, respectively. The median time of ACPP after SG placements was 15.2(95%CI, 8.3\u0026ndash;22.1) months. TLPP after SG placement at 6, 12, and 24 months was 91.3%, 67.6%, and 44.5%, \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003erespectively\u003c/span\u003e. The median time of TLPP after SG placements was 21.5 (95%CI, 15.8,27.1) months (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA and Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKaplan\u0026ndash;Meier curve of stent grafts (SGs).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 months\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 months\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36 months\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTLPP (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e91.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e37.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACPP (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e80.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e24.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eAbbreviation: ACPP, access circuit primary patency; TLPP, target lesion primary patency.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTLPP of SGs in different location\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003es\u003c/span\u003e, that is, SCV, BCV, and SVC, was compared, \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eand there was\u003c/span\u003e no significant difference among the three groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.830) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB). Subjects were divided into two groups according to whether \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe target lesions were stenos\u003c/span\u003eis (n\u0026thinsp;=\u0026thinsp;30) or occlusion\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003es (n\u0026thinsp;=\u0026thinsp;29) to compare TLPP\u003c/span\u003e after SG implantation. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe TLPP was higher in the stenosis group than in the occlusion group, but\u003c/span\u003e the difference was not significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.165) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eC).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eTLPP was improved by SGs\u003c/h2\u003e \u003cp\u003eTLPP before and after SG implantation was compared in a subgroup of 38 patients who had at least one PTA prior \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eto SG placement\u003c/span\u003e. The median intervention time post-SG implantation was significantly higher than that \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eafter\u003c/span\u003e proximate PTA pre-SG implantation [15.8 (9.6, 23.8) vs. 3.8(2.2, 7) months, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001]. The median intervention time of every EVT post-SG implantation was also higher than \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethat pre-SG implantation [10.0 (5.9, 23.2) vs.\u003c/span\u003e 3.8 (2.4, 6.3) months, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001] (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePredictive outcome factors of SGs\u003c/h2\u003e \u003cp\u003eCox proportional hazards analysis was used to investigate the impact of preoperative and perioperative factors on TLPP. Multivariate analysis revealed that \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ea\u003c/span\u003e target lesion length \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eof \u0026ge;\u0026thinsp;30\u003c/span\u003e mm and defects in \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe procedure\u003c/span\u003e were independent predictor\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003es of target lesion failure (\u003c/span\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e).\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate and multivariate Cox proportional hazards regression analyses of TLPP\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnivariate model\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eMultivariate model\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eMultivariate model\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003eMultivariate model\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHR(95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHR(95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHR(95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eHR(95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex(Female/Male)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.880(0.406\u0026ndash;1.906)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.745\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(\u0026ge;57/\u0026lt;57years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.726(0.340\u0026ndash;1.552)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.409\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus (Yes/No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.842(0.368\u0026ndash;1.930)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.685\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAV access type(AVG/AVF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.850(1.206\u0026ndash;6.736)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.842(0.632\u0026ndash;5.371)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.846(0.601\u0026ndash;5.666)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e1.310(0.394\u0026ndash;4.362)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0.659\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation of AV access(Right/Left upper extremity)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.732(0.328\u0026ndash;1.635)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.446\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of ipsilateral CVC insertion, months(Yes/No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.206(0.552\u0026ndash;2.638)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.638\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTarget lesion length(\u0026ge;30/\u0026lt;30mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.741(1.663\u0026ndash;8.412)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.558(1.545\u0026ndash;13.448)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e4.578(1.268\u0026ndash;16.526)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e5.914(1.525\u0026ndash;22.937)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation of target lesion\u003c/p\u003e \u003cp\u003esuperior vena cava\u003c/p\u003e \u003cp\u003ebrachiocephalic vein\u003c/p\u003e \u003cp\u003esubclavian vein\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e1.604(0.370\u0026ndash;6.960)\u003c/p\u003e \u003cp\u003e1.129(0.233\u0026ndash;5.475)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.645\u003c/p\u003e \u003cp\u003e0.528\u003c/p\u003e \u003cp\u003e0.880\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcross costoclavicular joint(No/Yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.058(1.416\u0026ndash;6.608)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.625(0.580\u0026ndash;4.553)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.355\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.623(0.563\u0026ndash;4.678)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.370\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e2.284(0.706\u0026ndash;7.388)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0.168\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDefects of procedure(Yes/No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11.822(4.860-28.757)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14.020(3.687\u0026ndash;53.317)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e14.022(3.678\u0026ndash;53.324)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e13.960(3.571\u0026ndash;54.573)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStent diameter/adjacent distal vessel diameter ratio (\u0026ge;\u0026thinsp;1/\u0026lt;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.036(0.954\u0026ndash;17.075)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.350(0.511\u0026ndash;10.814)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2.349(0.510-10.815)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e2.175(0.458\u0026ndash;10.320)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0.328\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of SG (\u0026ge;\u0026thinsp;100/\u0026lt;100mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.733(0.802\u0026ndash;3.745)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.993(0.307\u0026ndash;3.208)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.990\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e1.082(0.322\u0026ndash;3.635)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0.899\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBranch covered by SG\u003c/p\u003e \u003cp\u003e(Yes/No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.929(0.374\u0026ndash;2.307)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.873\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiple approach imaging for stent positioning(Yes/No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.700(0.313\u0026ndash;1.562)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.383\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTarget lesion type\u003c/p\u003e \u003cp\u003e(Occlusion/Stenosis)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.704(0.796\u0026ndash;3.648)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.769(0.760\u0026ndash;4.120)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.769(0.758\u0026ndash;4.127)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e1.295(0.499\u0026ndash;3.361)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0.595\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood flow post-SG(\u0026ge;1000/\u0026lt;1000ml/min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.790(0.365\u0026ndash;1.709)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.549\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApproach(Other route/Fistula only)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.566(0.652\u0026ndash;3.763)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.316\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEVT prior SG(Yes/No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.936(0.409\u0026ndash;2.142)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.875\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSharp canalization(Yes/No)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.687(0.637\u0026ndash;4.468)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.292\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e3.382(0.900-12.704)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"12\"\u003eAbbreviation: AV, arteriovenous; AVF, arteriovenous fistula; AVG, arteriovenous graft;CI, Confidenc interval༛CVC, central venous catheter; EVT, endovascular treatment; HR, Hazard ratio; SG, stent graft; TLPP, target lesion primary patency; The cut-off of age and procedure time were median values. Model\u003csup\u003ea\u003c/sup\u003e, Variables with a value of \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.1 in the univariate analysis were input into the multivariate Cox regression analysis. Model\u003csup\u003eb\u003c/sup\u003e, Variables with a value of \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.2 in the univariate analysis were input into the multivariate Cox regression analysis. Model\u003csup\u003ec\u003c/sup\u003e, Variables with a value of \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.3 in the univariate analysis were input into the multivariate Cox regression analysis.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eCVOD has become a common problem for vascular access specialist\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003es as the dialysis population continue\u003c/span\u003es to increase, \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eand the use of CVC has increase\u003c/span\u003ed. The guidelines\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e recommend that asymptomatic CVOD do not need to be treated. For symptomatic CVOD, treatment includes surgery (such as surgical bypass or medial claviculectomy) and EVT. EVT, which is less invasive than surgical bypass, \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ewith comparable short-term patency\u003c/span\u003e, is the preferred intervention\u003csup\u003e[\u003cspan additionalcitationids=\"CR15 CR16\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. However, EVT also has disadvantages, such as elastic recoil and restenosis after PTA, which seriously affect the quality \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eof life of patients and increases medical expenses\u003c/span\u003e\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. More recent studies have shown superiority of SGs over both PTA and bare-metal stents in terms of long-term patency\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn this study, we analyzed the patency of 59 SG implantation procedures for CVOD. The ACPP \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003erates at 6, 12, and 24 months post-SG placement\u003c/span\u003e were 80.9%, 53.8%, and 31.4%, respectively. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe TLPP at 6, 12, and 24 months post-SG placement was\u003c/span\u003e 91.3%, 67.6%, and 44.5%, \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003erespectively\u003c/span\u003e. A previous cohort study \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethat included 60 cases with Excluder SGs for CVOD found that ACPP was 54.9% and TLPP was 88.3% at 12 months\u003c/span\u003e\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. Another study showed that TLPP and ACPP with SGs for CVOD at 12 months were 56% and 29%\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. In a study of 30 patients treated with Viabahn SGs for CVOD, TLPP was 97%, 81%, 67%, and 45% at 3, 6, 12, and 24 months, respectively\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. The results of our study were generally consistent with those reported in the literature, which may be related to factors such as single-center studies, stricter indications, and greater consistency in \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe surgical procedures.\u003c/span\u003e\u003c/p\u003e \u003cp\u003eIn subgroup analysis, TLPP with SG in \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe stenosis group was superior to that in the occlusive group, although the difference was not statistically significant.\u003c/span\u003e This suggests that lesions should be identified early and treated at the stenotic stage, \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003erather than\u003c/span\u003e evolving to occlusion. Jones et al. \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e reported \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eresults\u003c/span\u003e similar to ours, \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ewhich showed that p\u003c/span\u003eatients with occlusive lesions had a significantly shorter primary patency interval (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0 .05) than those with stenosis. Occluded veins were more likely to require SGs (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02). From another perspective, \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe procedures spent more time in the occlusive group than in the stenosis group [65(45,107.5) vs.45(38,60) min\u003c/span\u003e, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002]. Our study also found that SG use improved the intervention interval and reduced the number of interventions in patients who had previously undergone PTA. Jones et al. indic\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eated that SG placement\u003c/span\u003e to treat CVOD in HD patients was safe and effective if PTA failed to maintain luminal patency\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Gong et al. concluded that SG placement to salvage central vein stenosis stents with recalcitrant restenosis in patients with AV fistulas is safe and effective if PTA failed \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. Our results were consistent with Vachharajani et al.\u0026rsquo;\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003es\u003c/span\u003e viewpoint that \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eSG\u003c/span\u003e implantation seems to benefit the TLPP and has been shown to reduce the number of interventions needed to maintain access patency\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOur study found \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethat a target\u003c/span\u003e lesion length\u0026thinsp;\u0026ge;\u0026thinsp;30 mm was a predictive factor, whereas stent length was not. Previous studies have suggested stent length as a predictive factor\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e, but our study, which was much more numerous, did not find it to be statistically significant. Theoretically, the longer the target lesion, the longer the stent length. In fact, because of the accessibility of the stents, six did not completely cover the lesion, and most of the stent lengths we used were the three specifications: 5 \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ecm (19 grafts)\u003c/span\u003e, 7 \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ecm (14 grafts), and\u003c/span\u003e 10 \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ecm (21\u003c/span\u003e grafts). The selection of stent length should consider not only the length of the target lesion, \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ebut also whether the stent\u003c/span\u003e has good runoff after release. Our results also showed that \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eprocedural defects\u003c/span\u003e were predictive factor\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003es\u003c/span\u003e. For good distal runoff grafts, the runoff of \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe SG\u003c/span\u003es and the vessel are consistent without serious angulation, which could reduce the blood flow disorder of marginal SGs, thus reducing the probability of distal edge stenosis of the SGs. Another reason is that SGs did not completely cover the lesion, which means intimal hyperplasia of the target lesion will continue to cause stenosis, which would be aggravated by the disordered blood flow of the stent edge\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWe found, \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003efor the first time, that the blood flow of AV access was not statistically significant for TLPP. High\u003c/span\u003e blood flow could stimulate intimal hyperplasia and accelerate stent marginal stenosis\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e, but most of the included \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003epatients were not high-flow patients, and the median blood flow was 1000 ml/min. Patients with high-flow AV access and central venous lesions are not\u003c/span\u003e indicated for stents.\u003c/p\u003e \u003cp\u003eCompared with same-sized/oversized stents for central venous lesions, undersized stents did not show \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ean advantage for TLPP. We should declare that the undersized stent diameter was compared to the distal marginal vessels, which was different from the AVG outflow tract stent\u003c/span\u003e\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. Gilbert et al. evaluated the effect of \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ea WRAPSODYTM Cell-impermeable Endoprosthesis in\u003c/span\u003e treating AV access circuit stenosis. In this study, devices were deployed in a 10\u0026ndash;25% oversized configuration (vs. adjacent healthy vessel) with at least 1 cm overlap with \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ea healthy vessel or\u003c/span\u003e synthetic graft. Eleven devices were placed in \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe central vein\u003c/span\u003e and \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe 12-month TLPP\u003c/span\u003e was 100%\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. A \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003erecent\u003c/span\u003e study proposed that undersized stent\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003es ha\u003c/span\u003eve better primary patency\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. Our results showed that undersized stent\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003es had no advantage over same-sized/oversized stents\u003c/span\u003e, probably because the assessment of \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe central venous diameter was not accurate\u003c/span\u003e and could be influenced by respiration and balloon dilation. Another reason may be the small sample size.\u003c/p\u003e \u003cp\u003eThe present study has some limitations. First, this was a retrospective study conducted at a single center, which would affect the reproducibility of the results. Second, the present study had a short follow-up \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eduration. T\u003c/span\u003ehus, more prospective randomized controlled trials should be performed to evaluate the effectiveness and safety of SG treatment in the future.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and patient population\u003c/h2\u003e \u003cp\u003eThis study was conducted by retrospectively analyzing prospectively collected data involving a cohort of patients who rece\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eived SGs for CVOD treatment between\u003c/span\u003e August 2018 and June 2022 at the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eCVOD was defined as symptomatic vascular\u003c/span\u003e stenosis or obstruction by a lesion located in \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe central venous system\u003c/span\u003e consisting of the subclavian vein (SCV), brachiocephalic vein (BCV), and superior vena cava (SVC); however, \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe internal jugular vein was excluded. The indications for SG placement include occlusive lesions, acute elastic recoil\u0026thinsp;\u0026gt;\u0026thinsp;30% after PTA, and restenosis within 3 months of balloon angioplasty for the same lesion. Fifty-nine SG placement procedures were performed in 54 patients and 61 SGs were implanted in the cohort. Follow-up ended on D\u003c/span\u003eecember 31, 2022, with access abandonment, patient death, or loss to follow-up. This study has been performed in accordance with the Declaration of Helsinki and was approved by the Human Research Ethics Committee of the First Affiliated Hospital of Zhengzhou University. Informed consent was obtained from all patients prior to the procedure.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eProcedures\u003c/h2\u003e \u003cp\u003eAll procedures were performed under local anesthesia. Digital subtraction angiography (DSA) was conducted before all EVT procedures to evaluate the lesions, and some \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ewere combined with\u003c/span\u003e computed tomography angiography (CTA). Viabahn\u0026trade; (W. L. Gore \u0026amp; Associates Inc., CA, USA), Fluency \u003csup\u003eTM\u003c/sup\u003e Plus (Bard Peripheral Vascular, Tempe, Arizona, USA), \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eor Excluder\u003c/span\u003e\u0026trade; AAA contralateral leg (W. L. Gore \u0026amp; Associates Inc., CA, USA) SGs, with a diameter matching the adjacent vessel and length covering the entire target lesion, were selected based on the physician\u0026rsquo;s judgement. The treatment was performed at a single center by a well-trained interventional nephrologist. The first choice of approach is AVF outflow or \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe venous limb of the AVG. However, the femoral vein\u003c/span\u003e or other approaches are needed in some cases. Unfractionated heparin (1000\u0026ndash;5000 IU) was injected into the sheath to prevent clotting. We often used 0.035 inch guidewire cooperated with a single curved catheter or a long sheath to cross the severe stenosis lesion, known as \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe blunt recanalization technique.\u003c/span\u003e For the total occlusive lesion, we often used \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ea sharp recanalization technique\u003c/span\u003e\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. SGs was performed after angioplasty using a noncompliant balloon. All SGs were dilated using the balloon size used in the initial angioplasty procedure. Procedure duration was defined as the interval between the start of percutaneous puncture and \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe remov\u003c/span\u003eal of vascular sheaths. Procedures were judged by two \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eother operators to evaluate\u003c/span\u003e poor runoff or incomplete coverage of the lesion. Rivaroxaban (10\u0026ndash;\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e20 mg/day) was prescribed\u003c/span\u003e without \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eany contraindications within the first month after SG placement.\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eFollow-up\u003c/h2\u003e \u003cp\u003eAll patients underwent regular hemodialysis. Clinic\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eal or telephone surveillance\u003c/span\u003e was performed quarterly during \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe follow-up period. Symptoms related\u003c/span\u003e to superior vena cava syndrome were the key points of routine surveillance, \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eand venography were recommended\u003c/span\u003e when patients were suspected \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eto have significant restenosis. EVT was performed according to the indications recommended by the KDOQI\u003c/span\u003e Vascular Access guidelines\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eDefinition\u003c/h2\u003e \u003cp\u003eClinical success was defined as the ability to complete at least one \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eHD session after SG placement. Patency was defined according to the Committee on Reporting Standards for\u003c/span\u003e Arteriovenous Access by the Society for Vascular Surgery and the American Association for Vascular Surgery. Target lesion primary patency (TLPP) was defined as the interval from any EVT until reintervention in \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe target lesions. Access Circuit\u003c/span\u003e Primary Patency (ACPP) after SG refers to the interval from SG placement until reintervention in the access circuit\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Major complications were defined as those that required additional treatment.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eSPSS 23.0 and Prism 9.0, \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ewere applied for statistical processing, and the measurement data were expressed\u003c/span\u003e as mean and standard deviation, \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eand the count data were expressed as the number of cases and percentages, which were tested for normality using the Kolmogorov-Smi\u003c/span\u003ernov method. When comparing two groups of measurement data, \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003et-test\u003c/span\u003e was used for normal data and \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe non-parametric test\u003c/span\u003e was used for non-normal data. The Kaplan\u0026ndash;Meier method and log-rank test were used for survival curve analysis. Cox proportional hazards regression was used for predictive factor analysis of \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eSG patency\u003c/span\u003e. Statistical significance was set at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, SG placement to treat CVOD in HD patients is safe and effective, and could improve TLPP in patients who have previously undergone PTA. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eA\u003c/span\u003e target Lesion length\u0026thinsp;\u0026ge;\u0026thinsp;30 mm and defects in \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe procedure are\u003c/span\u003e predictors of TLPP.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eConflict of Interest Statement\u003c/h2\u003e \u003cp\u003eThe authors have no conflicts of interest to declare.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConception and design: YML, XHL, PW; Analysis and interpretation: YFW, YML, PW; Data collection: YML, BHZ, XFW, XHL; Writing the article: YML, XFW, XQL，PW; Final approval of the article: YFW, XQL, PW; Statistical analysis: YFW, YML; Overall responsibility: PW\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eThe authors thank all the patients and researchers who participated in this study. The authors are also thankful to the medical team of Blood Purification Center of the First Affiliated Hospital of Zhengzhou University for their assistance and support.\u003c/p\u003e\u003ch2\u003eData availability\u003c/h2\u003e \u003cp\u003eThe datasets used and/or analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBEATHARD G A. Percutaneous transvenous angioplasty in the treatment of vascular access stenosis [J]. Kidney Int, 1992, 42(6): 1390\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMACRAE J M, AHMED A, JOHNSON N, et al. Central vein stenosis: a common problem in patients on hemodialysis [J]. ASAIO J, 2005, 51(1): 77\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAGARWAL A K. Central vein stenosis [J]. Am J Kidney Dis, 2013, 61(6): 1001\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLOK C E, HUBER T S, LEE T, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update [J]. Am J Kidney Dis, 2020, 75(4 Suppl 2): S1-S164.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHASKAL Z J, TREROTOLA S, DOLMATCH B, et al. Stent graft versus balloon angioplasty for failing dialysis-access grafts [J]. N Engl J Med, 2010, 362(6): 494\u0026ndash;503.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJONES R G, WILLIS A P, JONES C, et al. Long-term results of stent-graft placement to treat central venous stenosis and occlusion in hemodialysis patients with arteriovenous fistulas [J]. J Vasc Interv Radiol, 2011, 22(9): 1240\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eULLOA J G, KIRKPATRICK V E, WILSON S E, et al. Stent salvage of arteriovenous fistulas and grafts [J]. Vasc Endovascular Surg, 2014, 48(3): 234\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCHEN B, LIN R, DAI H, et al. One-year outcomes and predictive factors for primary patency after stent placement for treatment of central venous occlusive disease in hemodialysis patients [J]. Ther Adv Chronic Dis, 2022, 13: 20406223211063039.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBOUTROUS M L, ALVAREZ A C, OKOYE O T, et al. Stent-Graft Length Is Associated with Decreased Patency in Treatment of Central Venous Stenosis in Hemodialysis Patients [J]. Ann Vasc Surg, 2019, 59: 225\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMCDEVITT J L, SRINIVASA R N, GEMMETE J J, et al. Approach, Technical Success, Complications, and Stent Patency of Sharp Recanalization for the Treatment of Chronic Venous Occlusive Disease: Experience in 123 Patients [J]. Cardiovasc Intervent Radiol, 2019, 42(2): 205\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSCHMIDLI J, WIDMER M K, BASILE C, et al. Editor's Choice - Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS) [J]. Eur J Vasc Endovasc Surg, 2018, 55(6): 757\u0026ndash;818.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSIDAWY A N, GRAY R, BESARAB A, et al. Recommended standards for reports dealing with arteriovenous hemodialysis accesses [J]. J Vasc Surg, 2002, 35(3): 603\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Y, Liang X, Zhou CY, Lu X, Wang P. Two cases of guidewire entering extravascular space then reentering the true lumen during sharp recanalization of superior vena cava occlusion[J]. Chinese Journal of Nephrology, 2022, 38(3): 238\u0026ndash;240.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSFYROERAS G S, ANTONOPOULOS C N, MANTAS G, et al. A Review of Open and Endovascular Treatment of Superior Vena Cava Syndrome of Benign Aetiology [J]. Eur J Vasc Endovasc Surg, 2017, 53(2): 238\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKALRA M, GLOVICZKI P, ANDREWS J C, et al. Open surgical and endovascular treatment of superior vena cava syndrome caused by nonmalignant disease [J]. J Vasc Surg, 2003, 38(2): 215\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRIZVI A Z, KALRA M, BJARNASON H, et al. Benign superior vena cava syndrome: stenting is now the first line of treatment [J]. J Vasc Surg, 2008, 47(2): 372\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAUYANG P L, CHAUHAN Y, LOH T M, et al. Medial claviculectomy for the treatment of recalcitrant central venous stenosis of hemodialysis patients [J]. J Vasc Surg Venous Lymphat Disord, 2019, 7(3): 420\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYILDIZ I. The Efficacy of Paclitaxel Drug-Eluting Balloon Angioplasty Versus Standard Balloon Angioplasty in Stenosis of Native Hemodialysis Arteriovenous Fistulas: An Analysis of Clinical Success, Primary Patency and Risk Factors for Recurrent Dysfunction [J]. Cardiovasc Intervent Radiol, 2019, 42(5): 685\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVESELY T M, SIEGEL J B. Use of the peripheral cutting balloon to treat hemodialysis-related stenoses [J]. J Vasc Interv Radiol, 2005, 16(12): 1593\u0026ndash;603.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKARNABATIDIS D, KITROU P, SPILIOPOULOS S, et al. Stent-grafts versus angioplasty and/or bare metal stents for failing arteriovenous grafts: a cross-over longitudinal study [J]. J Nephrol, 2013, 26(2): 389\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eANAYA-AYALA J E, SMOLOCK C J, COLVARD B D, et al. Efficacy of covered stent placement for central venous occlusive disease in hemodialysis patients [J]. J Vasc Surg, 2011, 54(3): 754\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFALK A, MAYA I D, YEVZLIN A S, et al. A Prospective, Randomized Study of an Expanded Polytetrafluoroethylene Stent Graft versus Balloon Angioplasty for In-Stent Restenosis in Arteriovenous Grafts and Fistulae: Two-Year Results of the RESCUE Study [J]. J Vasc Interv Radiol, 2016, 27(10): 1465\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCHEN Y Y, WU C K, LIN C H. Outcomes of the Gore Excluder abdominal aortic aneurysm leg endoprosthesis for treatment of central vein stenosis or occlusion in patients with chronic hemodialysis [J]. J Vasc Surg Venous Lymphat Disord, 2020, 8(2): 195\u0026ndash;204.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGONG M, ZHOU Y, ZHAO B, et al. Efficacy of stent-graft placement to salvage central vein stents with recalcitrant restenosis in patients with arteriovenous fistulas [J]. Semin Dial, 2020, 33(5): 382\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVACHHARAJANI T J, TALIERCIO J J, ANVARI E. New Devices and Technologies for Hemodialysis Vascular Access: A Review [J]. Am J Kidney Dis, 2021, 78(1): 116\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSIVANANTHAN G, MENASHE L, HALIN N J. Cephalic arch stenosis in dialysis patients: review of clinical relevance, anatomy, current theories on etiology and management [J]. J Vasc Access, 2014, 15(3): 157\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSTOVE C, KINGSMORE D B, STEVENSON K S, et al. The impact of stent-graft sizing on venous stenosis re-intervention and arteriovenous graft patency: Free-floating stent outflow is associated with improved outcomes [J]. J Vasc Access, 2022: 11297298221137152.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGILBERT J, RAI J, KINGSMORE D, et al. First Clinical Results of the Merit WRAPSODY Cell-Impermeable Endoprosthesis for Treatment of Access Circuit Stenosis in Haemodialysis Patients [J]. Cardiovasc Intervent Radiol, 2021, 44(12): 1903\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHUANG E P, LI M F, HSIAO C C, et al. Undersized stent graft for treatment of cephalic arch stenosis in arteriovenous hemodialysis access [J]. Sci Rep, 2020, 10(1): 12501.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-3916835/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3916835/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eTo assess the effectiveness and predictive factors of stent grafts (SGs) for the treatment of central venous obstruction disease (CVOD) in hemodialysis (HD) patients with arteriovenous (AV) access.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eHD patients with CVOD who underwent SGs at our center between August 2018 and June 2022 were enrolled. The Kaplan\u0026ndash;Meier method and log-rank test were used for survival curve analysis. SGs.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e59 SG implantation procedures for CVOD were analyzed \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eusing Cox proportional hazards regression for the predictive factor analysis.\u003c/span\u003e Thirty subjects had stenosis and 29 had occlusion. The access circuit primary patency (ACPP) after SG placement at 6, 12, and 24 months was 80.9%, 53.8%, and 31.4%, respectively. The target lesion primary patency (TLPP) after SG placement at 6, 12, and 24 months were 91.3%, 67.6%, and 44.5%, \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003erespectively. I\u003c/span\u003en \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe subgroup analysis, the TLPP was higher in the stenosis group than in the occlusion group, but the difference was not significant\u003c/span\u003e (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.165). \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe TLPP of procedures post-SG placement was significantly improved compared to th\u003c/span\u003eat \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ebefore\u003c/span\u003e SG placement (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Cox proportional hazards regression showed that \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ea target\u003c/span\u003e lesion length\u0026thinsp;\u0026ge;\u0026thinsp;30 \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003emm and procedural defects\u003c/span\u003e were independently associated with a lower TLPP after SG treatment for CVOD in HD patients.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eSG placement \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eis safe and effective for t\u003c/span\u003ehe treat\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ement of CVOD in HD patients\u003c/span\u003e. SG improves \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe TLPP\u003c/span\u003e of endovascular therapy (EVT) for CVOD. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eA\u003c/span\u003e target lesion length\u0026thinsp;\u0026ge;\u0026thinsp;30 mm and procedure \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003edefects were predictive factors\u003c/span\u003e for TLPP.\u003c/p\u003e","manuscriptTitle":"Clinical outcomes and predictive factors of stent grafts treatment for symptomatic central venous obstruction in end stage kidney disease patients with arteriovenous access","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-20 18:19:54","doi":"10.21203/rs.3.rs-3916835/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-04-01T10:34:18+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-03-17T08:42:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"6031b3e2-9c4d-47d1-87a6-4830371a317b","date":"2024-03-13T07:10:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-03-12T23:53:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-07T00:00:33+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-02-17T10:32:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-02-17T10:25:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-02-01T09:26:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"40bbc0c6-f6ea-40e6-b17f-ccc1d5862b81","owner":[],"postedDate":"February 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":28816408,"name":"Health sciences/Nephrology"},{"id":28816409,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2024-05-27T12:42:57+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-20 18:19:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3916835","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3916835","identity":"rs-3916835","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}