Division of Vascular Surgery, the First People's Hospital of Foshan, Foshan, China.
Br J Radiol. 2020 May 1;93(1109):20190505. doi: 10.1259/bjr.20190505. Epub 2020 Mar 4.
Percutaneous transluminal balloon angioplasty (PTA) is recommended as the first choice to treat stenosis of Brescia-Cimino arteriovenous fistulas (B-C AVFs). The ability to predict which B-C AVFs are at risk for recurrent stenosis post-PTA would allow closer monitoring of patients, and possibly result in surgical intervention rather than repeat PTA. The purpose of this study was to identify predictive factors of primary patency after PTA in B-C AVFs.
Patients diagnosed with B-C AVF primary stenosis and treated by PTA between November 2013 and March 2018 were included in the study. Patient and stenotic lesion characteristics and PTA procedure factors were included in the analysis. The Kaplan-Meier method was used to analyze the primary patency rate. Cox proportional hazard regression analysis was used to identify factors predictive of decreased primary patency.
74 patients (35 males, 39 females) with a mean age of 61.68 ± 11.44 years (range, 36-84 years) were included in the study. The mean B-C AVF age was 16.34 ± 12.93 months (range, 2-84 months), and the median primary patency time was 7.79 ± 0.48 months. Cox proportional hazard regression analysis revealed stenosis location at the inflow artery [hazard ratio (HR)=3.83, 95% confidence interval (CI): 1.46-10.09] or anastomosis (HR = 1.90, 95% CI: 1.09-3.32), dilation >2 times during PTA (HR = 2.30, 95% CI: 1.22-4.34), and residual stenosis >30% (HR = 2.42, 95% CI: 1.26-4.63) were significantly associated with decreased patency.
In conclusion, the primary patency rate of PTA for B-C AVF dysfunction is reduced by dilation >2 times, residual stenosis >30%, and stenosis located at the inflow artery or anastomosis. These results may help in tailoring surveillance programs, multiple PTA, or a proximal re-anastomosis surgery in patients with AVF dysfunction.
A number of studies have been conducted to examine the predictors of primary patency after PTA, however, no definitive conclusions have been reached. Our study revealed that stenosis location at the inflow artery or anastomosis, dilation >2 times during PTA, and residual stenosis >30% were the predictors of primary patency after PTA, which may help in tailoring surveillance programs, multiple PTA, or a proximal re-anastomosis surgery in patients with arteriovenous fistulas dysfunction.
经皮腔内血管成形术（PTA）被推荐为治疗 Brescia-Cimino 动静脉瘘（B-C AVF）狭窄的首选方法。能够预测 PTA 后哪些 B-C AVF 有复发性狭窄的风险，将允许更密切地监测患者，并可能导致手术干预而不是重复 PTA。本研究的目的是确定 PTA 后 B-C AVF 原发性通畅的预测因素。
本研究纳入了 2013 年 11 月至 2018 年 3 月期间因 B-C AVF 原发性狭窄接受 PTA 治疗的患者。分析了患者和狭窄病变特征以及 PTA 手术因素。Kaplan-Meier 法用于分析原发性通畅率。Cox 比例风险回归分析用于确定原发性通畅率降低的预测因素。
本研究纳入了 74 名患者（35 名男性，39 名女性），平均年龄为 61.68±11.44 岁（范围 36-84 岁）。B-C AVF 的平均年龄为 16.34±12.93 个月（范围 2-84 个月），中位原发性通畅时间为 7.79±0.48 个月。Cox 比例风险回归分析显示，狭窄位于流入动脉[风险比（HR）=3.83，95%置信区间（CI）：1.46-10.09]或吻合口（HR=1.90，95%CI：1.09-3.32）、PTA 时扩张>2 倍（HR=2.30，95%CI：1.22-4.34）和残余狭窄>30%（HR=2.42，95%CI：1.26-4.63）与通畅率降低显著相关。
总之，B-C AVF 功能障碍的 PTA 原发性通畅率降低与扩张>2 倍、残余狭窄>30%以及狭窄位于流入动脉或吻合口有关。这些结果可能有助于制定监测计划、多次 PTA 或 AVF 功能障碍患者的近端再吻合手术。
已经进行了许多研究来检查 PTA 后原发性通畅的预测因素，但尚未得出明确的结论。我们的研究表明，流入动脉或吻合口处的狭窄位置、PTA 时扩张>2 倍以及残余狭窄>30%是 PTA 后原发性通畅的预测因素，这可能有助于制定监测计划、多次 PTA 或 AVF 功能障碍患者的近端再吻合手术。
