Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Zhejiang, China.
Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Zhejiang, China.
Ann Vasc Surg. 2023 Jul;93:234-242. doi: 10.1016/j.avsg.2023.01.014. Epub 2023 Jan 30.
This retrospective cohort study was to determine the factors related to restenosis post percutaneous transluminal angioplasty (PTA) at juxta-anastomotic of wrist radial-cephalic arteriovenous fistulas (RC-AVFs).
We conducted a retrospective study of patients who underwent their first PTA for juxta-anastomotic stenosis at RC-AVF from January 1, 2016, to December 31, 2020. Patient and stenotic lesion characteristics and PTA procedure factors were included in the analysis. The primary and assisted primary patency post PTA of RC-AVFs were evaluated using the Kaplan-Meier analysis and log-rank test. A Cox proportional hazard model was used to identify factors associated with restenosis post PTA. The receiver operating characteristic (ROC) curve was employed to evaluate the predictive value of the risk factors for restenosis post PTA.
A total of 65 patients with a mean age of 59.09 ± 14.94 years were enrolled in the study. The mean RC-AVF age was 9.2 (4.9, 35.05) months, and the median time of intervention for stenosis was 10.8 (4.05, 41.35) months after AVF creation. The primary patency rates following the first PTA at 3, 6, 12, and 24 months were 93.9, 84.6, 63.1, and 55.4%, respectively. The assisted primary patency rates at 3, 6, 12, and 24 months were 95.4, 90.8, 87.7, and 84.6%, respectively. Cox proportional hazard regression analysis revealed the maximum balloon diameter >5 mm had a lower postoperative restenosis rate compared with the maximum balloon diameter ≤5 mm (hazard ratio = 0.422; 95% confidence interval [CI]: 0.201-0.884; P = 0.022). ROC curve analysis showed that the area under the curve of the maximum balloon diameter during PTA was 0.624 (95% CI, 0.486-0.762). The best critical value for the maximum balloon diameter was 6 mm, the sensitivity was 64.5%, and the specificity was 61.8%.
For the first PTA at juxta-anastomotic of wrist RC-AVFs without thrombosis and complete occlusion, the use of a balloon with a maximum diameter of ≤5 mm is a risk factor to the occurrence of restenosis within 12 months post PTA. The result may help in tailoring surveillance programs in patients with RC-AVF stenosis.
本回顾性队列研究旨在确定经皮腔内血管成形术（PTA）治疗腕部桡尺动静脉瘘（RC-AVF）吻合口近吻合处再狭窄的相关因素。
我们对 2016 年 1 月 1 日至 2020 年 12 月 31 日期间首次接受 PTA 治疗 RC-AVF 吻合口近吻合处狭窄的患者进行了回顾性研究。分析了患者和狭窄病变特征以及 PTA 手术因素。使用 Kaplan-Meier 分析和对数秩检验评估 RC-AVF 经 PTA 后的主要和辅助主要通畅率。采用 Cox 比例风险模型确定 PTA 后再狭窄的相关因素。采用受试者工作特征（ROC）曲线评估 PTA 后再狭窄风险因素的预测价值。
共纳入 65 例患者，平均年龄 59.09±14.94 岁。RC-AVF 平均年龄为 9.2（4.9，35.05）个月，狭窄介入治疗的中位时间为 AVF 建立后 10.8（4.05，41.35）个月。首次 PTA 后 3、6、12 和 24 个月的主要通畅率分别为 93.9%、84.6%、63.1%和 55.4%。3、6、12 和 24 个月的辅助主要通畅率分别为 95.4%、90.8%、87.7%和 84.6%。Cox 比例风险回归分析显示，最大球囊直径>5mm 与最大球囊直径≤5mm 相比，术后再狭窄率较低（风险比=0.422；95%置信区间[CI]：0.201-0.884；P=0.022）。ROC 曲线分析显示，PTA 期间最大球囊直径的曲线下面积为 0.624（95%CI，0.486-0.762）。最大球囊直径的最佳临界值为 6mm，灵敏度为 64.5%，特异性为 61.8%。
对于无血栓和完全闭塞的腕部 RC-AVF 吻合口近吻合处的首次 PTA，使用最大直径≤5mm 的球囊是 PTA 后 12 个月内再狭窄发生的危险因素。该结果可能有助于为 RC-AVF 狭窄患者制定监测方案。
