Bountouris Ioannis, Kristmundsson Thorarinn, Dias Nuno, Zdanowski Zbigniew, Malina Martin
Skåne University Hospital, Vascular Center, 205 02 Malmö, Sweden.
Int J Vasc Med. 2014;2014:369687. doi: 10.1155/2014/369687. Epub 2014 Jan 22.
Purpose. Our objective was to evaluate the outcome of percutaneous transluminal angioplasty (PTA) and particularly rePTA in a failing arteriovenous fistula (AV-fistula). Are multiple redilations worthwhile? Patients and Methods. All 159 stenoses of AV fistulas that were treated with PTA, with or without stenting, during 2008 and 2009, were included. Occluded fistulas that were dilated after successful thrombolysis were also included. Median age was 68 (interquartile range 61.5-78.5) years and 75% were male. Results. Seventy-nine (50%) of the primary PTAs required no further reintervention. The primary patency was 61% at 6 months and 42% at 12 months. Eighty (50%) of the stenoses needed at least one reintervention. Primary assisted patency (defined as patency after subsequent reinterventions) was 89% at 6 months and 85% at 12 months. The durability of repeated PTAs was similar to the durability of the primary PTA. However, an early primary PTA carried a higher risk for subsequent reinterventions. Successful dialysis was achieved after 98% of treatments. Nine percent of the stenoses eventually required surgical revision and 13% of the fistulas failed permanently. Conclusion. The present study suggests that most failing AV-fistulas can be salvaged endovascularly. Repeated PTA seems similarly durable as the primary PTA.
目的。我们的目标是评估经皮腔内血管成形术（PTA）的效果，特别是在功能不良的动静脉内瘘（AV内瘘）中再次进行PTA的效果。多次再扩张是否值得？患者与方法。纳入了2008年至2009年期间接受PTA治疗（无论是否置入支架）的所有159例AV内瘘狭窄病例。还纳入了成功溶栓后扩张的闭塞内瘘病例。中位年龄为68岁（四分位间距61.5 - 78.5岁），75%为男性。结果。79例（50%）初次PTA无需进一步干预。6个月时初次通畅率为61%，12个月时为42%。80例（50%）狭窄至少需要一次再干预。初次辅助通畅率（定义为后续再干预后的通畅率）6个月时为89%，12个月时为85%。重复PTA的耐久性与初次PTA相似。然而，早期进行初次PTA会增加后续再干预的风险。98%的治疗后实现了成功透析。9%的狭窄最终需要手术修正，13%的内瘘永久失败。结论。本研究表明，大多数功能不良的AV内瘘可通过血管腔内治疗挽救。重复PTA的耐久性似乎与初次PTA相似。
