Zheng Quan, Xie Bingying, Xie Xinfu, Zhang Wenhao, Hou Jihua, Feng Zhonglin, Tao Yiming, Yu Feng, Zhang Li, Ye Zhiming
Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China.
Department of Nephrology, Shantou University Medical College, Shantou, China.
Ann Transl Med. 2021 Jan;9(2):132. doi: 10.21037/atm-20-7690.
The objective of this study was to assess postintervention patency and analyze the predictive factors associated with early and late restenosis after intervention in hemodialysis arteriovenous fistulas (AVF) and arteriovenous grafts (AVG).
This study retrospectively analyzed 284 hemodialysis patients who underwent percutaneous transluminal angioplasty (PTA) due to AVF and AVG stenosis. A total of 350 PTA procedures were performed. Clinical, anatomical, biochemical, and technical variables were analyzed. Using univariate and multivariate analyses, we assessed the postintervention patency of PTA by follow-up, and identified the predictive factors taking into account competing risks.
Postintervention patency rates at 3, 6, 12, and 24 months were 86.5%, 66.4%, 42.6%, and 29.8%, respectively, with a median patency duration of 11±0.71 months. Kaplan-Meier analysis showed that the patency rate of the AVF group (n=271) was dramatically higher than the AVG group (n=79) at 3, 6, and 12 months after PTA, respectively (88.9% . 78.5%, 69.0% . 57.4%, 48.8% . 20.0%, P<0.01). Cox survival analysis revealed that the factors associated with postintervention patency of AVF included age of fistulas, serum albumin (ALB) levels, location of stenoses, lesion length longer than 2 cm, multiple stenoses, and maximal pressure of dilatation lower than 16 atm. In addition, factors related to postintervention patency of AVG included the presence of diabetes and hypertension, and serum ALB.
This study demonstrated that the risk factors associated with postintervention patency of AVF included age of fistulas, lower levels of serum ALB, location of stenoses, lesion length longer than 2 cm, multiple stenoses, and maximal pressure of dilatation lower than 16 atm. In addition, risk factors related to postintervention patency of AVG included the presence of diabetes and lower levels of serum ALB, while the presence of hypertension was found to be a protective factor for reducing patency loss of AVG. Among all these factors, serum ALB and multiple stenoses tended to predict early restenosis, while pressure of dilatation tended to predict late restenosis.
本研究的目的是评估干预后的通畅情况，并分析与血液透析动静脉内瘘（AVF）和动静脉移植物（AVG）干预后早期和晚期再狭窄相关的预测因素。
本研究回顾性分析了284例因AVF和AVG狭窄而接受经皮腔内血管成形术（PTA）的血液透析患者。共进行了350例PTA手术。对临床、解剖、生化和技术变量进行了分析。通过单因素和多因素分析，我们通过随访评估了PTA干预后的通畅情况，并确定了考虑竞争风险的预测因素。
干预后3、6、12和24个月的通畅率分别为86.5%、66.4%、42.6%和29.8%，中位通畅持续时间为11±0.71个月。Kaplan-Meier分析显示，PTA术后3、6和12个月，AVF组（n=271）的通畅率显著高于AVG组（n=79）（分别为88.9%对78.5%、69.0%对57.4%、48.8%对20.0%，P<0.01）。Cox生存分析显示，与AVF干预后通畅相关的因素包括内瘘年龄、血清白蛋白（ALB）水平、狭窄部位、病变长度大于2 cm、多处狭窄以及扩张最大压力低于16个大气压。此外，与AVG干预后通畅相关的因素包括糖尿病和高血压的存在以及血清ALB。
本研究表明，与AVF干预后通畅相关的危险因素包括内瘘年龄、血清ALB水平较低、狭窄部位、病变长度大于2 cm、多处狭窄以及扩张最大压力低于16个大气压。此外，与AVG干预后通畅相关的危险因素包括糖尿病的存在和血清ALB水平较低，而高血压的存在被发现是减少AVG通畅丧失的保护因素。在所有这些因素中，血清ALB和多处狭窄倾向于预测早期再狭窄，而扩张压力倾向于预测晚期再狭窄。
