Nephrology and Dialysis Unit, "Cannizzaro" Hospital, Catania, Italy.
Nephrology and Dialysis Unit, "San Giovanni Di Dio" Hospital, Agrigento, Italy.
J Vasc Access. 2021 Sep;22(5):739-743. doi: 10.1177/1129729820943076. Epub 2020 Jul 25.
Stenosis is the main cause of arteriovenous fistula failure and is due to neointimal hyperplasia. Percutaneous transluminal angioplasty is the gold standard for patients with vascular access stenosis. The aim of the study was to evaluate the efficacy and safety of ultrasound-guided percutaneous transluminal angioplasty in the treatment of native arteriovenous fistula venous stenosis.
The need for intervention was determined by physical examination and duplex ultrasound in 162 patients. All patients with failing or not maturing arteriovenous fistula were treated in the outpatient setting under ultrasound guidance. Procedural success was assessed with repeated post-procedural ultrasound examinations. All procedures were performed under local anesthesia by a single nephrologist and were performed in a single vascular laboratory, while follow-up ultrasound was performed in the dialysis unit of destination.
Early technical success was obtained in 95.6% of cases (154 of 162). Complications occurred in 22 patients (13.5%) with no major complication requiring surgical or fluoroscopic endovascular intervention. Primary patency at 6 and 12 months was 84% and 69.8%, respectively. Risk factors for arteriovenous fistula failure/secondary percutaneous transluminal angioplasty were vascular access low blood flow rate and vintage, as well as the need for thrombolysis during the first percutaneous transluminal angioplasty.
Ultrasound-guided percutaneous transluminal angioplasty is a valuable tool to treat vascular access stenosis.
狭窄是动静脉瘘失败的主要原因，是由新生内膜增生引起的。经皮腔内血管成形术是血管通路狭窄患者的金标准。本研究旨在评估超声引导下经皮腔内血管成形术治疗自体动静脉瘘静脉狭窄的疗效和安全性。
162 例患者通过体格检查和双功能超声确定是否需要介入治疗。所有动静脉瘘功能不良或不成熟的患者均在超声引导下于门诊进行治疗。通过重复术后超声检查评估手术成功率。所有手术均由一名肾脏病医生在局部麻醉下进行，在单一血管实验室进行，而后续超声检查则在目的地透析单位进行。
早期技术成功率为 95.6%（154/162）。22 例（13.5%）患者发生并发症，无需要手术或荧光透视血管内介入治疗的重大并发症。6 个月和 12 个月时的一期通畅率分别为 84%和 69.8%。动静脉瘘失败/二次经皮腔内血管成形术的风险因素是血管通路低血流率和陈旧性，以及首次经皮腔内血管成形术中需要溶栓。
超声引导下经皮腔内血管成形术是治疗血管通路狭窄的有效工具。
