Efficacy of peripheral cutting balloon in the treatment of long stenosis of arteriovenous fistula and influencing factors of restenosis after treatment
10.3760/cma.j.cn441217-20231120-01120
- VernacularTitle:外周切割球囊治疗动静脉内瘘长段狭窄的疗效及治疗后再狭窄的影响因素
- Author:
Shen ZHAN
1
;
Bin ZHAO
;
Hui WANG
;
Lihong ZHANG
;
Yuzhu WANG
Author Information
1. 北京大学第三医院海淀院区（北京市海淀医院）肾内科，北京 100080
- Keywords:
Renal dialysis;
Arteriovenous fistula;
Risk factors;
Peripheral cutting balloon;
Stenosis
- From:
Chinese Journal of Nephrology
2024;40(7):533-539
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the efficacy and safety of peripheral cutting balloon (PCB) in the treatment of long stenosis of arteriovenous fistula, and to explore the influencing factors of restenosis after PCB treatment.Methods:It was a single-center retrospective study. The patients with long stenosis (>2 cm) of arteriovenous fistula who received PCB treatment of percutaneous transluminal angioplasty (PTA) in Haidian Hospital, the Third Hospital of Peking University from August to November 2021. The clinical and follow-up data after PTA operation were collected and analyzed, and the primary patency rate and primary assist patency rate of fistula at 3, 6 and 12 months after PTA operation were calculated. Kaplan-Meier method was used to draw the survival curve of the primary patency rate of fistula, and log-rank test was used to compare the differences of primary patency rates of fistula between two groups. Multivariate Cox regression analysis was used to analyze the influencing factors of fistula restenosis after PCB treatment.Results:A total of 65 patients aged (62.57±11.55) years old were included in this study, including 42 males (64.62%), 61 (93.85%) autologous arteriovenous fistula and 4 (6.15%) arteriovenous graft. The narrowest diameter of fistula stenosis ( t=-41.731, P<0.001) and brachial artery blood flow ( t=-12.510, P<0.001) after PCB treatment were significantly higher than those before PCB treatment. The resistance index of fistula after PCB treatment was significantly lower than that before PCB treatment ( t=9.241, P<0.001). The technical success rate of PTA was 100% (65/65), and the clinical success rate of PTA was 96.92% (63/65). Only 2 patients failed to complete hemodialysis after PCB treatment, and no serious postoperative complications occurred. The follow-up time was 12 (7, 13) months. Fistula dysfunction occurred in 24 patients (36.92%) within 12 months. Kaplan-Meier survival analysis showed that the primary patency rates were 90.77%, 81.54% and 63.08% at 3, 6, and 12 months, respectively, and the primary assist patency rate at 12 months was 100% (65/65). The risk of fistula restenosis in patients with long stenosis ≥36 mm was significantly higher than that in patients with long stenosis <36 mm (log-rank χ2=6.007, P=0.014). Multivariate Cox regression analysis showed that increased stenosis length ( HR=1.022, 95% CI 1.001-1.045, P=0.042) was an independent influencing factor of fistula restenosis within 12 months after PCB treatment. Conclusions:PCB is safe and effective in the treatment of long segment stenosis associated with fistula. The increased stenosis length is an independent influencing factor of restenosis in fistula after PCB treatment.
