J Vasc Interv Radiol. 2013 Dec;24(12):1765-72; quiz 1773. doi: 10.1016/j.jvir.2013.08.025.
To compare postpercutaneous intervention outcomes of autogenous venous-transposition arteriovenous fistulas (AVFs) versus those of autogenous nontransposed AVFs (nAVFs) and prosthetic arteriovenous grafts (AVGs).
A total of 591 hemodialysis accesses (195 transposed AVFs [tAVFs], 205 nAVFs, 191 AVGs) in 522 patients (278 male; mean age, 57 y; range, 15–91 y) underwent percutaneous transluminal angioplasty (PTA) and/or mechanical thrombectomy (ie, declotting). Access characteristics, surgical history, percutaneous interventions, postinterventional primary and secondary access patency, and follow-up data were collected. Cox proportional-hazards regression analyses, Fisher exact tests, and χ2 tests were performed.
Mean follow-up period was 32 months. Mean access ages at initial percutaneous intervention were 260 days (tAVF), 206 days (nAVF), and 176 days (AVG; P < .01). One-year postinterventional primary patency (PIPP) rates were 25% (tAVF), 24% (nAVF), and 14% (AVG). One-year postinterventional secondary patency (PISP) rates were 77% (tAVF), 61% (nAVF), and 63% (AVG). Median PIPP durations were 138 days (tAVF), 121 days (nAVF), and 79 days (AVG; P = .0001). Median PISP durations were 1,076 days (tAVF), 783 days (nAVF), and 750 days (AVG; P = .019). Total interventions needed to maintain PISP were 2.4 (tAVF), 1.3 (nAVF), and 3.2 (AVG) per patient-year (P < .001), which included 1.9, 1.2, and 1.4 PTAs (P < .01) and 0.45, 0.15, and 1.8 declotting procedures, respectively (P < .001).
Based on the number of percutaneous interventions needed to maintain PISP, these results confirm the current Dialysis Outcomes Quality Initiative access preference of nAVFs before tAVFs before AVGs. tAVFs offered superior postinterventional outcomes than AVGs. With additional interventions, tAVFs could even outperform nAVFs in terms of PISP.
比较自体静脉转位动静脉瘘（AVF）与自体非转位 AVF（nAVF）和人工动静脉移植物（AVG）经皮介入治疗后的结果。
522 例患者（278 例男性；平均年龄 57 岁；年龄范围 15～91 岁）共 591 例血液透析通路（195 例转位 AVF [tAVF]、205 例 nAVF、191 例 AVG）接受了经皮腔内血管成形术（PTA）和/或机械血栓切除术（即溶栓）。收集通路特征、手术史、经皮介入治疗、介入后原发性和继发性通路通畅性以及随访数据。进行 Cox 比例风险回归分析、Fisher 确切检验和 χ2 检验。
平均随访时间为 32 个月。初次经皮介入治疗时的平均通路年龄为 260 天（tAVF）、206 天（nAVF）和 176 天（AVG；P <.01）。1 年时的原发性通畅率（PIPP）分别为 25%（tAVF）、24%（nAVF）和 14%（AVG）。1 年时的继发性通畅率（PISP）分别为 77%（tAVF）、61%（nAVF）和 63%（AVG）。PIPP 的中位持续时间分别为 138 天（tAVF）、121 天（nAVF）和 79 天（AVG；P =.0001）。PISP 的中位持续时间分别为 1076 天（tAVF）、783 天（nAVF）和 750 天（AVG；P =.019）。为维持 PISP 所需的总介入次数为每患者年 2.4（tAVF）、1.3（nAVF）和 3.2（AVG）（P <.001），包括 1.9、1.2 和 1.4 次 PTA（P <.01）和 0.45、0.15 和 1.8 次溶栓（P <.001）。
基于维持 PISP 所需的经皮介入次数，这些结果证实了目前 Dialysis Outcomes Quality Initiative 对 nAVF 的通路偏好，即 nAVF 优先于 tAVF ，再优先于 AVG。tAVF 提供了比 AVG 更优的介入后结果。通过额外的介入治疗，tAVF 在 PISP 方面甚至可以优于 nAVF。
