Takahashi Edwin A, Harmsen William S, Misra Sanjay
Department of Radiology, Mayo Clinic, Rochester, MN.
Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, MN.
Kidney Med. 2020 Apr 21;2(3):326-331. doi: 10.1016/j.xkme.2020.02.004. eCollection 2020 May-Jun.
RATIONALE & OBJECTIVE: Primary patency is variable with arteriovenous fistulas, and many patients require angiographic procedures to obtain patency. Accordingly, we determined postintervention patency rates and contributing factors for fistula failure following intervention to establish secondary patency in non-dialysis-dependent patients with advanced chronic kidney disease following creation of an arteriovenous fistula.
Observational study from a single referral center.
SETTING & PARTICIPANTS: 210 non-dialysis-dependent patients with advanced chronic kidney disease who underwent upper-extremity fistula creation for anticipated dialysis between October 1995 and January 2015 and who required subsequent endovascular therapy to establish or maintain patency were reviewed.
Endovascular therapy for dialysis arteriovenous fistula primary patency failure.
Postintervention patency duration following endovascular therapy.
Descriptive study with outcomes determined using Cox proportional hazards models.
Multiple fistula configurations were reviewed: 138 (65.7%) brachiocephalic, 39 (18.6%) radiocephalic, 30 (14.3%) brachiobasilic, 2 (1.0%) ulnocephalic, and 1 (0.5%) radiobasilic. There were 261 initial stenoses treated. Postintervention primary patency is defined as the time from the index intervention to repeat intervention for stenosis. Postintervention primary-assisted patency is the time from the index intervention to thrombectomy for fistula thrombosis or change in modality. Postintervention secondary patency is the time from the index intervention to fistula abandonment. Median postintervention primary patency, postintervention primary-assisted patency, and secondary patency were 2.7, 3.2, and 3.6 years, respectively. The overall 1-year primary, primary-assisted, and secondary patency rates in this cohort were 53.0%, 87.7%, and 83.5%, respectively. Compared with radiocephalic fistulas, brachiocephalic fistulas had higher risk for postintervention primary patency loss (HR, 1.90; 95% CI, 1.13-3.20; = 0.02).
Dialysis fistula revascularization techniques varied.
The radiocephalic fistula configuration had the best postintervention primary patency in this cohort. Postintervention primary-assisted patency and secondary patency were not significantly different among different fistula configurations.
动静脉内瘘的初始通畅率存在差异，许多患者需要进行血管造影检查以实现通畅。因此，我们确定了干预后的通畅率以及干预后内瘘失败的相关因素，以便在晚期慢性肾脏病非透析依赖患者建立动静脉内瘘后实现二期通畅。
来自单一转诊中心的观察性研究。
回顾了210例晚期慢性肾脏病非透析依赖患者，这些患者于1995年10月至2015年1月期间接受上肢内瘘造瘘术以预期进行透析，且随后需要进行血管内治疗以建立或维持通畅。
针对透析动静脉内瘘初始通畅失败的血管内治疗。
血管内治疗后的干预后通畅持续时间。
采用Cox比例风险模型确定结局的描述性研究。
回顾了多种内瘘构型：138例（65.7%）为头臂型，39例（18.6%）为桡动脉-头静脉型，30例（14.3%）为肱动脉-尺静脉型，2例（1.0%）为尺动脉-头静脉型，1例（0.5%）为桡动脉-尺静脉型。共治疗了261处初始狭窄。干预后初始通畅定义为从首次干预至因狭窄再次干预的时间。干预后初级辅助通畅是指从首次干预至因内瘘血栓形成进行取栓术或改变透析方式的时间。干预后二期通畅是指从首次干预至内瘘废弃的时间。干预后初始通畅、干预后初级辅助通畅和二期通畅的中位时间分别为2.7年、3.2年和3.6年。该队列中总体1年初始通畅率、初级辅助通畅率和二期通畅率分别为53.0%、87.7%和83.5%。与桡动脉-头静脉型内瘘相比，头臂型内瘘干预后初始通畅丧失风险更高（风险比，1.90；95%置信区间，1.13 - 3.20；P = 0.02）。
透析内瘘血管重建技术存在差异。
在该队列中，桡动脉-头静脉型内瘘构型干预后初始通畅情况最佳。不同内瘘构型的干预后初级辅助通畅和二期通畅无显著差异。
