Pro-Renal Brasil, Centro de Nefrologia Intervencionista, Curitiba, PR, Brasil.
Faculdade Evangélica Mackenzie do Paraná, Curitiba, PR, Brasil.
J Bras Nefrol. 2022 Apr-Jun;44(2):196-203. doi: 10.1590/2175-8239-JBN-2021-0085.
Arteriovenous fistulas (AVF) are the first choice vascular access for hemodialysis. However, they present a high incidence of venous stenosis leading to thrombosis. Although training in interventional nephrology may improve accessibility for treatment of venous stenosis, there is limited data on the safety and efficacy of this approach performed by trained nephrologists in low-income and developing countries.
This study presents the retrospective results of AVF angioplasties performed by trained nephrologists in a Brazilian outpatient interventional nephrology center. The primary outcome was technical success rate (completion of the procedure with angioplasty of all stenoses) and secondary outcomes were complication rates and overall AVF patency.
Two hundred fifty-six angioplasties were performed in 160 AVF. The technical success rate was 88.77% and the main cause of technical failure was venous occlusion (10%). The incidence of complications was 13.67%, with only one patient needing hospitalization and four accesses lost due to the presence of hematomas and/or thrombosis. Grade 1 hematomas were the most frequent complication (8.2%). The overall patency found was 88.2 and 80.9% at 180 and 360 days after the procedure, respectively.
Our findings suggest that AVF angioplasty performed by trained nephrologists has acceptable success rates and patency, with a low incidence of major complications as well as a low need for hospitalization.
动静脉瘘（AVF）是血液透析的首选血管通路。然而，它们存在较高的静脉狭窄发生率，导致血栓形成。尽管介入肾脏病学培训可能会提高治疗静脉狭窄的可及性，但在低收入和发展中国家，由经过培训的肾病学家进行这种治疗的安全性和疗效的数据有限。
本研究回顾性分析了巴西一家门诊介入肾脏病学中心由经过培训的肾病学家进行的 AVF 血管成形术的结果。主要结局是技术成功率（所有狭窄处均行血管成形术完成手术），次要结局是并发症发生率和 AVF 总通畅率。
在 160 个 AVF 中进行了 256 次血管成形术。技术成功率为 88.77%，技术失败的主要原因是静脉闭塞（10%）。并发症发生率为 13.67%，仅 1 例患者因血肿和/或血栓形成需要住院治疗，4 个通路丢失。最常见的并发症是 1 级血肿（8.2%）。术后 180 天和 360 天的总通畅率分别为 88.2%和 80.9%。
我们的研究结果表明，由经过培训的肾病学家进行的 AVF 血管成形术具有可接受的成功率和通畅率，主要并发症发生率低，住院需求低。
