Division of Cardiology, Department of Internal Medicine, Mokdong Hospital, School of Medicine, Ewha Womans University, Seoul, Korea.
Korean Circ J. 2011 Sep;41(9):512-7. doi: 10.4070/kcj.2011.41.9.512. Epub 2011 Sep 29.
Dysfunction of arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) contributes significantly to morbidity and hospitalization in the dialysis population. We evaluated the primary patency of AVFs following percutaneous transluminal angioplasty (PTA) in haemodialysis patients.
We performed 231 interventions in 118 patients with a mean age of 62.1±12.9 years. We performed 122 interventions in 53 AVG patients (44.9%), and 109 interventions in 65 AVF patients (55.1%). If there was thrombosis of the vascular access, urokinase was administered and/or thrombus aspiration was performed. The stent was inserted when balloon dilatation did not expand sufficiently or elastic recoil occurred.
For the 118 patients, the median patency time was 10.45±10.29 months at 92 months of follow-up. The primary patencies for stenotic AVFs at 6, 12, 24, 36, 48, and 60 months were 63.4%, 41.4%, 17.0%, 9.7%, 7.3%, and 2.4%, respectively. The primary patencies for AVGs at 6, 12, 24, and 36 months were 36.9%, 19.5%, 10.8%, 2.1%, respectively, and were obtained by means of the Kaplan-Meier analysis (log rank=6.42, p<0.05). The median patency time was 11.0 months and 4.45 months in the non-thrombus and thrombus groups, respectively. The complication rate was 1.73% (4/231); two cases of pseudoaneurysms and two cases of extravasation were detected. All therapy failures (5/231) occurred in thrombotic lesions of AVGs and were treated surgically.
PTA is an efficacious method for the correction of stenosis of AVFs for hemodialysis, thus prolonging the patency of the fistulas.
动静脉瘘（AVF）和动静脉移植物（AVG）功能障碍显著增加了透析人群的发病率和住院率。我们评估了经皮腔内血管成形术（PTA）治疗血液透析患者后 AVF 的一期通畅率。
我们对 118 名平均年龄为 62.1±12.9 岁的患者进行了 231 次介入治疗。53 名 AVG 患者（44.9%）接受了 122 次介入治疗，65 名 AVF 患者（55.1%）接受了 109 次介入治疗。如果血管通路发生血栓形成，给予尿激酶并/或血栓抽吸。如果球囊扩张不能充分扩张或发生弹性回缩，则插入支架。
在 118 名患者中，中位随访 92 个月时的通畅时间为 10.45±10.29 个月。狭窄性 AVF 在 6、12、24、36、48 和 60 个月的一期通畅率分别为 63.4%、41.4%、17.0%、9.7%、7.3%和 2.4%。AVG 在 6、12、24 和 36 个月的一期通畅率分别为 36.9%、19.5%、10.8%和 2.1%，通过 Kaplan-Meier 分析获得（对数秩=6.42，p<0.05）。无血栓组和血栓组的中位通畅时间分别为 11.0 个月和 4.45 个月。并发症发生率为 1.73%（4/231）；发现 2 例假性动脉瘤和 2 例外渗。所有治疗失败（5/231）均发生在 AVG 的血栓性病变中，并进行了手术治疗。
PTA 是治疗血液透析患者 AVF 狭窄的有效方法，可延长瘘管的通畅时间。
