经皮腔内血管成形术用于动静脉内瘘促成熟治疗的效果及术后初级通畅时间的影响因素分析

Curative effect of percutaneous transluminal angioplasty on promoting maturity of arteriovenous fistula and the influencing factors of postoperative primary patency time

目的探讨经皮腔内血管成形术(PTA)用于动静脉内瘘(AVF)成熟治疗的临床效果及术后初级通畅时间的影响因素。方法回顾性分析2017年1月至2019年12月于南京医科大学第二附属医院肾脏病中心经血管超声评估为AVF成熟不良,随即行PTA治疗77例患者的临床资料和随访资料。观察患者PTA术后3、6、12个月初级通畅率,比较PTA术后6个月AVF有无再干预组的一般资料和不同临床因素AVF患者PTA术后初级通畅时间,分析PTA术后AVF初级通畅时间的影响因素。结果 PTA术后2周内77例患者AVF均可穿刺使用,技术成功率及临床成功率均为100%。PTA术后3、6、12个月初级通畅率分别为93.5%(72/77)、76.6%(59/77)、75.3%(58/77)。术后6个月未干预组59例,再干预组18例,2组性别、年龄,高血压、糖尿病比例,穿刺置鞘入路、术中使用球囊大小和狭窄部位比较差异均无统计学意义(均P> 0.05);未干预组AVF建立时间短于再干预组[(3.7±1.8)个月比(3.9±1.4)个月](P <0.05)。不同性别、年龄、穿刺入路、球囊大小、狭窄部位患者初级通畅时间比较差异均无统计学意义(均P> 0.05);AVF建立时间<3个月患者PTA术后初级通畅时间长于≥3个月患者[(19.3±1.3)个月比(15.3±1.5)个月]。AVF建立时间≥3个月为PTA术后初级通畅时间的危险因素(风险比=2.240,95%置信区间:1.018~4.926,P=0.045)。结论 AVF成熟不良需要及早诊断并进行干预治疗,PTA是一种安全有效的促成熟治疗手段,早期接受PTA促成熟治疗可获得更长的干预后初级通畅时间。

Objective To analyze the clinical effect of percutaneous transluminal angioplasty(PTA)on promoting maturity of autologous arteriovenous fistula(AVF)and influencing factors of postoperative primary patency time.Methods The clinical and follow-up data of 77 patients with AVF dysmaturity diagnosed by vascular ultrasound in Nephrology Center,the Second Affiliated Hospital of Nanjing Medical University from January 2017 to December 2019 were retrospectively analyzed.The primary patency rate of patients at 3,6 and 12 months after PTA was recorded.Six months after PTA,the basic characteristics of patients were compared between groups with or without AVF re-intervention,and the primary patency time in AVF patients with different clinical factors after PTA was compared.The influencing factors of postoperative primary patency time were analyzed.Results AVF could be used in 77 patients within 2 weeks after PTA,and the technical success rate and clinical success rate were 100%.The primary patency rates followed-up for 3,6 and 12 months after PTA were 93.5%(72/77),76.6%(59/77)and 75.3%(58/77),respectively.Six months after PTA,59 patients in non-intervention group and 18 patients in re-intervention group,there were no significant differences in gender,age,the proportion of hypertension and diabetes mellitus,puncture and sheath approach,the size of balloon during operation,and stenotic site between the two groups(all P>0.05).The AVF establishment time in the non-intervention group was shorter than that in the re-intervention group[(3.7±1.8)months vs(3.9±1.4)months](P<0.05).There were no significant differences in primary patency time among patients with different gender,age,puncture approach,balloon size and stenotic site(all P>0.05).The primary patency time after PTA in patients with AVF age<3 months was longer than that in patients with AVF age≥3 months[(19.3±1.3)months vs(15.3±1.5)months].The AVF age≥3 months was a risk factor of primary patency time after PTA(hazard ratio=2.240,95%confidence interval:1.018-4.926,P=0.045).Conclusions The non-maturing AVF demands early diagnosis and treatment.PTA is a safe and effective method to promote maturity of AVF.A longer post-intervention primary patency time can be obtained by early PTA promoting maturity treatment.