球囊辅助成熟技术治疗小口径头臂静脉桡动脉内瘘的长期疗效及影响因素分析
Long-term efficacy and risk factors of balloon-assisted maturation for radial-cephalic arteriovenous fistula with small-caliber veins.
机构信息
Thoracic and Cardiovascular Department, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.
出版信息
Hemodial Int. 2023 Jul;27(3):241-248. doi: 10.1111/hdi.13091. Epub 2023 May 3.
INTRODUCTION
Balloon angioplasty maturation (BAM) is a salvage method for autologous arteriovenous fistula (AVF) maturation failure. AVF creation using small-diameter veins is considered to have poor outcomes. Therefore, this study aimed to explore the long-term patency of small-diameter veins (≤3 mm) using BAM.
METHODS
BAM was performed if the fistula failed to mature and function adequately to provide prescribed dialysis.
FINDINGS
Out of 61 AVFs, 22 AVFs successfully matured without further intervention (AVF group) and 39 AVFs failed to mature. Except for 1 patient who required peritoneal dialysis, the remaining 38 patients received salvage BAM, and 36 of those successful matured (BAM group). Kaplan-Meier analysis revealed no significant differences between the AVF and BAM groups in terms of primary functional patency (p = 0.503) and assisted functional patency (p = 0.499). Compared with the AVF group, the BAM group had similar assisted primary functional patency (1-year: 94.7% vs. 93.1%; 3-year: 88.0% vs. 93.1%; 5-year: 79.2% vs. 88.3%). In addition, there were no significant difference between groups in the duration of primary functional patency and assisted primary functional patency (p > 0.05). Multivariate analyses showed that vein diameter and number of BAM procedures were independent predictors of primary functional patency in the AVF group and BAM group, respectively. Patient with 1 mm increase in vein size had 0.13-fold probability of having decreased duration of patency (HR = 0.13, 95% CI: 0.02-0.99, p = 0.049), while patients who received two times of BAM procedures were 2.885 as likely to have decreased duration of primary functional patency (HR = 2.885, 95% CI: 1.09-7.63, p = 0.033) than patients who received one BAM procedure.
DISCUSSION
BAM is a relatively effective salvage management option with an acceptable long-term patency rate, even for small cephalic veins.
简介
球囊血管成形术成熟（BAM）是自体动静脉瘘（AVF）成熟失败的挽救方法。使用小直径静脉进行 AVF 构建被认为结局较差。因此，本研究旨在探讨使用 BAM 治疗小直径静脉（≤3mm）的长期通畅率。
方法
如果瘘管未能成熟且无法充分发挥规定的透析功能，则进行 BAM。
结果
在 61 个 AVF 中，22 个 AVF 无需进一步干预即可成功成熟（AVF 组），39 个 AVF 未成熟。除了 1 名需要腹膜透析的患者外，其余 38 名患者接受了挽救性 BAM，其中 36 名成功成熟（BAM 组）。Kaplan-Meier 分析显示，在原发性功能通畅率方面，AVF 组和 BAM 组无显著差异（p=0.503），在辅助性功能通畅率方面也无显著差异（p=0.499）。与 AVF 组相比，BAM 组的辅助原发性功能通畅率相似（1 年：94.7% vs. 93.1%；3 年：88.0% vs. 93.1%；5 年：79.2% vs. 88.3%）。此外，两组原发性功能通畅时间和辅助原发性功能通畅时间无显著差异（p>0.05）。多变量分析显示，静脉直径和 BAM 次数是 AVF 组和 BAM 组原发性功能通畅率的独立预测因素。静脉大小增加 1mm，通畅时间缩短的概率降低 0.13 倍（HR=0.13，95%CI：0.02-0.99，p=0.049），而接受两次 BAM 治疗的患者原发性功能通畅时间缩短的概率是接受一次 BAM 治疗患者的 2.885 倍（HR=2.885，95%CI：1.09-7.63，p=0.033）。
讨论
BAM 是一种相对有效的挽救治疗选择，具有可接受的长期通畅率，即使是小的头静脉也是如此。
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