Miyamoto Kanyu, Sato Takashi, Momohara Keisuke, Ono Sumihisa, Yamaguchi Makoto, Katsuno Takayuki, Sakurai Hiroshi, Imai Hirokazu, Ito Yasuhiko
Department of Nephrology, Kizawa Memorial Hospital, Minokamo, Japan.
Vascular Access Treatment Center, Kaikoukai Central Clinic, Nagoya, Japan.
J Vasc Access. 2020 Nov;21(6):892-899. doi: 10.1177/1129729820910555. Epub 2020 Mar 13.
Although percutaneous transluminal angioplasty has been established as a first-line therapy for access failure in dialysis, there are few reports on primary patency after percutaneous transluminal angioplasty. We investigated factors associated with primary patency following the first percutaneous transluminal angioplasty performed after vascular access construction in patients with arteriovenous fistula, including blood flow volume before and after percutaneous transluminal angioplasty and previously reported factors.
We used medical records at six dialysis centers to retrospectively identify and analyze prognostic factors for primary patency after percutaneous transluminal angioplasty in 159 patients with arteriovenous fistula who underwent initial percutaneous transluminal angioplasty after vascular access construction.
Multivariate analysis with the Cox proportional hazard model showed that primary patency after percutaneous transluminal angioplasty in patients with arteriovenous fistula was significantly associated with lesion length (hazard ratio, 1.76; 95% confidence interval, 1.01-3.07; P = 0.045), and blood flow volume after percutaneous transluminal angioplasty (hazard ratio, 0.71; 95% confidence interval, 0.60-0.84; P < 0.001). When blood flow volume after percutaneous transluminal angioplasty was classified into three categories, risks of outcome events defining the end of primary patency after percutaneous transluminal angioplasty were significantly lower for 400-630 mL/min (hazard ratio, 0.38; 95% confidence interval, 0.21-0.68; P = 0.001) and >630 mL/min (hazard ratio, 0.16; 95% confidence interval, 0.06-0.40; P < 0.001) compared with <400 mL/min.
Our study showed that blood flow volume after percutaneous transluminal angioplasty is an important prognostic factor for primary patency after percutaneous transluminal angioplasty in patients with arteriovenous fistula.
尽管经皮腔内血管成形术已被确立为透析通路失功的一线治疗方法，但关于经皮腔内血管成形术后初始通畅率的报道较少。我们研究了动静脉内瘘患者在血管通路建立后首次进行经皮腔内血管成形术后初始通畅率的相关因素，包括经皮腔内血管成形术前、后的血流量以及先前报道的相关因素。
我们使用六个透析中心的医疗记录，对159例动静脉内瘘患者在血管通路建立后首次接受经皮腔内血管成形术的初始通畅率预后因素进行回顾性识别和分析。
Cox比例风险模型的多因素分析显示，动静脉内瘘患者经皮腔内血管成形术后的初始通畅率与病变长度（风险比，1.76；95%置信区间，1.01 - 3.07；P = 0.045）以及经皮腔内血管成形术后的血流量（风险比，0.71；95%置信区间，0.60 - 0.84；P < 0.001）显著相关。当将经皮腔内血管成形术后的血流量分为三类时，与<400 mL/min相比，400 - 630 mL/min（风险比，0.38；95%置信区间，0.21 - 0.68；P = 0.001）和>630 mL/min（风险比，0.16；95%置信区间，0.06 - 0.40；P < 0.001）时，定义经皮腔内血管成形术后初始通畅结束的结局事件风险显著降低。
我们的研究表明，经皮腔内血管成形术后的血流量是动静脉内瘘患者经皮腔内血管成形术后初始通畅率的重要预后因素。
