Rush University Medical Center, Chicago, IL, USA.
Department of Research, Danbury Hospital, Danbury, CT, USA.
Vasc Endovascular Surg. 2021 Nov;55(8):823-830. doi: 10.1177/15385744211026452. Epub 2021 Jul 1.
Patients often require multiple access re-interventions to improve fistula patency and the overall usable lifespan of autogenous arteriovenous fistula (aAVF). There is no consensus on the appropriate number of re-interventions after which an access should be abandoned and new access placed. We evaluated whether repeated endovascular interventions for failing/failed aAVF are worthwhile or futile.
A retrospective review was performed on aAVFs created between 2009-2014. Fistula function was evaluated until January 2017. Functional fistula patency (FFP) was defined as the total time of functional fistula use for hemodialysis, from time of cannulation to time of measurement or fistula abandonment, including all interventions performed to maintain/reestablish patency. Primary outcomes were FFP duration and number of post-dialysis interventions.
The study included 163 patients. Mean age was 67 (SD = 15.03). The only variable statistically different between functional fistulas and abandoned fistulas was obesity (p = 0.03). At the end of the study period, 145 (89.0%) patients continued to have functional fistulas, and 73 (44.8%) patients died, but had functional fistulas at time of death. Median FFP for the functional group was 3.18 years (range 0.01-7.01 years) and median number of interventions was 1 (range 0-13). In 18 patients (11%), the fistula was abandoned, most commonly due to thrombosis (47.1%), followed by infection (23.5%). No fistula was abandoned because of an unacceptable rate of reintervention. Median FFP in the abandoned group was 0.91 years (range 0.03-5.30 years), and median number of interventions was 0 (range of 0-5).
Through repeated interventions on aAVFs, none of the patients in our study exhausted all hemodialysis access options prior to transplantation, death or loss to follow-up. These results may indicate repeated and/or more frequent revisions do not negatively affect the FFP nor do they increase the overall risk for abandonment of aAVFs.
患者通常需要多次介入以改善瘘管通畅性和自体动静脉瘘（aAVF）的整体可用寿命。对于应该放弃哪种通路并建立新的通路，尚无共识。我们评估了针对失败/失效的 aAVF 进行重复血管内介入治疗是否值得。
对 2009-2014 年间建立的 aAVF 进行回顾性分析。直至 2017 年 1 月评估瘘管功能。功能性瘘管通畅性（FFP）定义为从开始使用瘘管进行血液透析的总时间，包括所有为维持/恢复通畅性而进行的干预措施，直至测量或放弃瘘管的时间。主要结局为 FFP 持续时间和透析后干预次数。
该研究共纳入 163 例患者。平均年龄为 67 岁（标准差=15.03）。在功能性瘘管和废弃瘘管之间，唯一有统计学差异的变量是肥胖（p=0.03）。研究结束时，145 例（89.0%）患者仍保留有功能性瘘管，73 例（44.8%）患者死亡，但在死亡时仍有功能性瘘管。功能性组的中位 FFP 为 3.18 年（范围 0.01-7.01 年），中位干预次数为 1 次（范围 0-13 次）。18 例（11%）患者放弃了瘘管，最常见的原因是血栓形成（47.1%），其次是感染（23.5%）。没有瘘管因无法接受的再干预率而被放弃。废弃组的中位 FFP 为 0.91 年（范围 0.03-5.30 年），中位干预次数为 0（范围 0-5 次）。
通过对 aAVF 进行重复干预，我们研究中的患者在接受移植、死亡或失访之前，都没有用尽所有血液透析通路选择。这些结果可能表明重复和/或更频繁的修复不会对 FFP 产生负面影响，也不会增加废弃 aAVF 的总体风险。
