Department of Nephrology, Kanto Rosai Hospital, Kawasaki City, Kanagawa, Japan.
Department of Nephrology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan.
PLoS One. 2023 Mar 31;18(3):e0283844. doi: 10.1371/journal.pone.0283844. eCollection 2023.
Blood vessel rupture is a major complication associated with vascular access intervention therapy (VAIVT). However, information regarding the risk factors for ruptures related to VAIVT is limited. The purpose of this study was to investigate the risk factors for rupture during VAIVT. This was a single-center, retrospective observational study. Demographic, clinical, anatomical, and VAIVT procedure variables were reviewed and analyzed using multivariate logistic regression. The 211 patients included in the study underwent 628 VAIVT procedures from November 2019 to December 2021, and 20 blood vessel ruptures occurred. Patients with ruptures had significantly lower BMI (p = 0.043), shorter access vintage(p = 0.017), underwent VAIVT for the first time (p = 0.006), and had lower blood flow quantity (p = 0.005), lower brachial artery flow volume (p = 0.018), and higher resistance index (p = 0.011). The multivariate logistic regression revealed that receiving VAIVT for the first time (OR 5.95, 95%CI 1.01-34.84; p = 0.048) and high resistance index (OR 1.86, 95%CI 1.01-3.16; p = 0.02) were significantly associated with a high risk for rupture. Furthermore, receiver operating characteristic curve analysis to assess the sensitivity-specificity profiles of the resistance index for ruptures showed that the optimal threshold was 0.70 (sensitivity/specificity, 0.69/0.70). Heightened surveillance during vascular access intervention therapy is warranted, especially in patients undergoing VAIVT for the first time or patients with a high resistance index (> 0.70).
血管破裂是血管介入治疗（VAIVT）相关的主要并发症。然而，关于 VAIVT 相关破裂风险因素的信息有限。本研究旨在探讨 VAIVT 过程中破裂的风险因素。这是一项单中心、回顾性观察研究。使用多变量逻辑回归分析了人口统计学、临床、解剖和 VAIVT 程序变量。本研究共纳入 211 例患者，在 2019 年 11 月至 2021 年 12 月期间接受了 628 次 VAIVT 治疗，其中发生了 20 例血管破裂。破裂组患者的 BMI 显著较低（p = 0.043），血管通路使用时间较短（p = 0.017），首次接受 VAIVT 治疗（p = 0.006），血流量较低（p = 0.005），肱动脉血流量较低（p = 0.018），阻力指数较高（p = 0.011）。多变量逻辑回归显示，首次接受 VAIVT 治疗（OR 5.95，95%CI 1.01-34.84；p = 0.048）和高阻力指数（OR 1.86，95%CI 1.01-3.16；p = 0.02）与破裂风险显著相关。此外，评估阻力指数对破裂的灵敏度-特异性曲线分析显示，最佳阈值为 0.70（灵敏度/特异性，0.69/0.70）。在血管介入治疗期间需要加强监测，特别是在首次接受 VAIVT 治疗或阻力指数较高（> 0.70）的患者。
