van der Linden Joke, Smits Johannes H M, Assink Jan H, Wolterbeek Derk W, Zijlstra Jan J, de Jong Gijs H T, van den Dorpel Marinus A, Blankestijn Peter J
Departments of *Internal Medicine and Radiology, Rijnmond-Zuid Medical Center, Clara Location, Rotterdam, The Netherlands; Departments of Nephrology and Radiology, University Medical Center, Utrecht, The Netherlands; and Departments of Internal Medicine and Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
J Am Soc Nephrol. 2002 Mar;13(3):715-720. doi: 10.1681/ASN.V133715.
The efficacy of percutaneous transluminal angioplasty (PTA) is usually expressed as the angiographic result. Access flow (Qa) measurements offer a means to quantify the functional effects. This study was performed to evaluate the short-term functional and angiographic effects of PTA and to determine the longevity of the functional effects during the follow-up period. Patients with an arteriovenous graft (AVG) or an arteriovenous fistula (AVF) who were eligible for PTA (Qa values of <600 ml/min) were included. Ultrasound-dilution Qa measurements were obtained shortly before PTA and periodically after PTA, beginning 1 wk after the procedure. The short-term effects were expressed as the increase in Qa and the reduction of stenosis. The long-term effects were expressed as patency and the decrease in Qa after PTA. Ninety-eight PTA procedures for 60 patients (65 AVG and 33 AVF) were analyzed. Qa improved from 371 +/- 17 to 674 +/- 30 ml/min for AVG and from 304 +/- 24 to 638 +/- 51 ml/min for AVF (both P < 0.0001). In 66% (AVG) and 50% (AVF) of cases, Qa increased to levels of >600 ml/min. The degree of stenosis decreased from 65 +/- 3 to 17 +/- 2% for AVG and from 72 +/- 5 to 23 +/- 7% for AVF (both P < 0.005). The reduction of stenosis was not correlated with DeltaQa (r(2) = 0.066). Six-month unassisted patency rates after PTA were 25% for AVG and 50% for AVF. The decreases in Qa were 3.7 +/- 0.8 ml/min per d for AVG and 1.8 +/- 0.9 ml/min per d for AVF. Qa values before PTA and DeltaQa were correlated with the subsequent decrease in Qa (P < 0.005). In conclusion, Qa increases after PTA but, in a substantial percentage of cases, not to levels of >600 ml/min. Qa values before PTA and the increase in Qa were correlated with long-term outcomes, whereas angiographic results were not. These data, combined with literature data, suggest that there is optimal timing for PTA.
经皮腔内血管成形术（PTA）的疗效通常以血管造影结果来表示。通路血流量（Qa）测量提供了一种量化功能效果的方法。本研究旨在评估PTA的短期功能和血管造影效果，并确定随访期间功能效果的持续时间。纳入符合PTA条件（Qa值<600 ml/min）的动静脉移植物（AVG）或动静脉瘘（AVF）患者。在PTA前不久以及PTA后定期（术后1周开始）进行超声稀释法Qa测量。短期效果以Qa的增加和狭窄程度的降低来表示。长期效果以通畅率和PTA后Qa的降低来表示。对60例患者（65个AVG和33个AVF）的98次PTA手术进行了分析。AVG的Qa从371±17 ml/min提高到674±30 ml/min，AVF的Qa从304±24 ml/min提高到638±51 ml/min（均P<0.0001）。在66%（AVG）和50%（AVF）的病例中，Qa增加到>600 ml/min的水平。AVG的狭窄程度从6±3%降至17±2%，AVF的狭窄程度从72±5%降至23±7%（均P<0.005）。狭窄程度的降低与ΔQa无关（r²=0.066）。PTA后6个月的AVG无辅助通畅率为25%，AVF为50%。AVG的Qa每天降低3.7±0.8 ml/min，AVF为1.8±0.9 ml/min。PTA前的Qa值和ΔQa与随后的Qa降低相关（P<0.005）。总之，PTA后Qa增加，但在相当比例的病例中，未达到>600 ml/min的水平。PTA前的Qa值和Qa的增加与长期结果相关，而血管造影结果则不然。这些数据与文献数据相结合，提示PTA存在最佳时机。
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