Design, Materials and Methods: We employed the Taiwan National Health Insurance Research Database (NHIRD) from 1999 to 2010 to assess the recurrent occlusion requiring ST and longevity of AV fistula after ST in 1049 patients on regular HD, with or without antiplatelet drugs.
Results: From the propensity-score (PS)-matched NHIRD, Multivariate Cox model demonstrated that concomitant antiplatelet medication in the HD patients who received the first ST significantly reduced the duration of recurrent ST (adjusted hazard ratio (HR) 1.69; 95% confidence interval (CI) 1.22-2.35, p=0.002) and the longevity of the fistula (adjusted HR 1.79; 95% CI 1.31-2.46, p<0.001).
Conclusion: Treatment with antiplatelet drugs in HD patients did not prevent recurrent thrombosis requiring further ST, but significantly jeopardized the longevity of AV fistula after ST.
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Stents are currently used for a wide variety of indications such as treatment of benign or malignant tracheobronchial stenosis with good symptom relief, quality of life and performance status scores in patients undergoing treatment for malignant airway involvement. Airway stents are also indicated in selected cases of benign airway obstruction and closure of trachea-esophageal or other types of fistulous tracts involving the central airways. Self-expandable metallic stents offer distinct advantages such as ease of placement, avoidance of use of general anesthetics and specific disadvantages such as granulation tissue formation and difficulty in manipulation and removal after placement.
Current challenges in airway stenting include short and long term complications such as migration, granulation tissue, airway secretion management and stent infections. New technology is currently under development including drug-eluting airway stents, biodegradable stents and three-dimensional printing to achieve better conformation to the size and anatomy of the airway.]]>