Division of Nephrology, Department of Internal Medicine, Yuan's General Hospital, No. 162, Chenggong 1st Road, LingYa District, Kaohsiung City, 802, Taiwan, ROC.
Chronic Kidney Disease Education Center, Yuan's General Hospital, Kaohsiung, 802, Taiwan.
Clin Exp Nephrol. 2021 Jan;25(1):80-86. doi: 10.1007/s10157-020-01958-w. Epub 2020 Aug 27.
Percutaneous transluminal angioplasty (PTA) has generally replaced surgical procedures to treat arteriovenous fistula (AVF) dysfunction, but the predictors of post-intervention patency are highly variable. This study aimed to determine predictors of primary patency following PTA of dysfunctional AVF.
Retrospective analysis of first-time PTA of 307 AVF in 307 patients (171 males, mean age 64.3 ± 12.4 years). Demographic, clinical, anatomical and medication variables were reviewed and subjected to univariate and multivariate Cox regression analysis.
The post-intervention primary patency rates at 6, 12, 24, and 36 months were 76.3%, 58.3%, 43.2%, and 38.2%, respectively. The higher aortic arch calcification (AAC) grade patients were older, had higher incidence of comorbidities and cardiomegaly, and younger AVF age, but their dialysis vintage term was shorter and diastolic blood pressure was lower, and the maximum diameter of balloon angioplasty was mostly ≤ 6 mm, and had lower phosphorus level and less calcium-containing phosphate binder use. In multivariate Cox proportional hazard analysis, the presence of higher AAC grade [hazard ratio (95% confidence interval): (1.46 (1.02-2.09); p = 0.037)] and stenosis at upper arm [1.76 (1.16-2.67); p = 0.008] were associated with shorter post-intervention primary patency.
In conclusion, higher AAC grade and anatomic factor related to the location of AVF (upper arm) were the important predictors of AVF dysfunction after PTA. These results could assist in tailoring surveillance programs and performing appropriate interventions for risky AVF.
经皮腔内血管成形术（PTA）已普遍取代手术治疗动静脉瘘（AVF）功能障碍，但干预后通畅的预测因素差异很大。本研究旨在确定 PTA 治疗功能障碍性 AVF 后通畅的主要预测因素。
回顾性分析 307 例 307 例患者（171 例男性，平均年龄 64.3±12.4 岁）首次 PTA 的资料。回顾了人口统计学、临床、解剖和药物变量，并进行了单因素和多因素 Cox 回归分析。
术后 6、12、24 和 36 个月的通畅率分别为 76.3%、58.3%、43.2%和 38.2%。主动脉弓钙化（AAC）程度较高的患者年龄较大，合并症和心胸比的发生率较高，AVF 年龄较小，但透析时间较短，舒张压较低，球囊血管成形术的最大直径多≤6mm，且磷水平较低，含钙磷结合剂的使用较少。多因素 Cox 比例风险分析显示，较高的 AAC 分级（危险比（95%置信区间）：1.46（1.02-2.09）；p=0.037）和上臂狭窄（1.76（1.16-2.67）；p=0.008）与术后通畅时间较短相关。
综上所述，较高的 AAC 分级和与 AVF 位置相关的解剖因素（上臂）是 PTA 后 AVF 功能障碍的重要预测因素。这些结果可以帮助制定监测计划，并对高危 AVF 进行适当的干预。
