切割球囊治疗血管通路相关性狭窄的疗效分析

The clinical efficacy of peripheral cutting balloon angioplasty for hemodialysis access stenosis

目的评估切割球囊(peripheral cutting balloon,PCB)治疗血管通路相关狭窄的有效性和安全性。方法回顾性分析2019年9月30日~2020年9月30日在北京市海淀医院肾内科使用PCB进行经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)治疗的患者,收集临床资料及手术后相关随访资料,统计手术后3、6、12个月的初级通畅率及初级辅助通畅率。结果共纳入107例患者,其中自体动静脉内瘘组(autogenous arteriovenous fistulas,AVF)76例,移植物内瘘组(arteriovenous graft,AVG)31例,2组技术成功率及临床成功率均为100%;AVF组平均狭窄开放压力为(8.68±1.20)atm;AVG组平均狭窄开放压力为(9.35±1.66)atm,2组比较差异无统计学意义(t=-2.037,12个月初级通畅率分别为67.7%、38.7%和25.8%;AVF组与AVG组3个月初级通畅率比较,差异有统计学意义(χ^(2)=4.415,P=0.036);2组6个月和12个月的初级通畅率比较无统计学差异(χ^(2)=0.567,P=0.451;χ^(2)=2.499,P=0.114);AVF组6个月、12个月初级辅助通畅率分别为65.8%和72.4%;AVG组在6个月、12个月初级辅助通畅率分别为58.1%和61.3%,2组比较差异无统计学意义(χ^(2)=0.567,P=0.451;χ^(2)=1.267,P=0.260);使用Log-Rank检验进一步比较2组累积通畅率,AVF组优于AVG组(χ^(2)=4.338,P=0.037)。结论切割球囊治疗血管通路相关性狭窄是安全、有效的,且AVF的效果优于AVG,但因随访时间及病例数有限,尚需进一步研究观察。

Objective To evaluate the efficacy and safety of peripheral cutting balloon(PCB)angioplasty in the treatment of stenosis in autogenous arteriovenous fistula(AVF)or arteriovenous graft(AVG).Methods The maintenance hemodialysis patients treated with percutaneous transluminal angioplasty using PCB angioplasty in Beijing Haidian Hospital from September 2019 to September 2020 were retrospectively analyzed.Their clinical and follow-up data,primary patency and primary assisted patency after the operation for 3,6and 12 months were recruited.Results A total of 107 patients were enrolled in this study,including patients with AVF group(n=76)and those with AVG group(n=31).The technical success rate and clinical success rate were 100%in both groups.The mean pressure of opening stenosis was 8.68±1.20 atm in AVF group,and9.35±1.66 atm in AVG group(t=-2.037,P=0.058).The primary patency rates after the operation for 3,6 and12 months were 85.5%,57.9%and 42.1%respectively in AVF group,and were 67.7%,38.7%and 25.8%respectively in AVG group(χ^(2)=4.415,P=0.036 after 3 months;χ^(2)=0.567,P=0.45 after 6 months;χ^(2)=2.499,P=0.114 after 12 months).The primary assisted patency rates after the operation for 6 and 12 months were 65.8%and 72.4%respectively in AVF group,and were 58.1%and 61.3%respectively in AVG group(χ^(2)=0.567,P=0.451 after 6 months;χ^(2)=1.267,P=0.260 after 12 months).Log-rank test showed that the cumulative patency rate was higher in AVF group than in AVG group(χ^(2)=4.338,RR=1.28,P=0.037).Conclusions PCB angioplasty is effective and safe in the treatment of hemodialysis access stenosis,and has better effects in AVF group than in AVG group.However,the effects of this method need to be further investigated due to our less patient number and shorter follow-up period.