自体动静脉内瘘狭窄病变经皮腔内球囊扩张血管成形术后初级通畅时间的影响因素

Factors of primary patency time after percutaneous transluminal angioplasty in stenotic lesions of autogenous arteriovenous fistula

目的探讨自体动静脉内瘘(AVF)狭窄病变经皮腔内球囊扩张血管成形术(PTA)后初级通畅时间的影响因素。方法收集2016年1月至2020年12月于重庆医科大学附属第一医院连续2次以上进行PTA治疗的202例AVF狭窄患者的临床资料,测量患者数字减影血管造影(DSA)下的狭窄部位、狭窄长度、狭窄程度以及治疗后的残余狭窄情况,分析AVF狭窄患者PTA术后对初级通畅时间的影响因素。结果PTA术后6、12个月,202例AVF患者293处狭窄病变初级通畅率分别为62.4%(126/202)、23.8%(48/202),不同性别、年龄、基础疾病、狭窄病变数量、狭窄程度、狭窄长度及球囊扩张后残余狭窄病变的初级通畅时间比较,差异均无统计学意义(P﹥0.05);不同狭窄部位的初级通畅时间比较,差异有统计学意义(P﹤0.05)。128例单一病变患者分析结果显示,近吻合口静脉狭窄与回流静脉段狭窄的初级通畅时间比较,差异有统计学意义(P﹤0.05);不同性别、年龄、基础疾病、狭窄长度、狭窄程度、残余狭窄病变的初级通畅时间比较,差异均无统计学意义(P﹥0.05)。202例患者中,59例患者有连续3次PTA治疗记录,按照首次PTA治疗后不同初级通畅时间将其分为<120 d组(n=20)、120~200 d组(n=21)、﹥200 d组(n=18),二次PTA后的初级通畅时间分别为125.00(88.75,205.75)、200.00(122.00,299.00)、217.00(134.50,412.50)d,3组患者二次PTA后的初级通畅时间比较,差异有统计学意义(P﹤0.05)。结论狭窄长度、狭窄程度对PTA治疗预后均无影响,病变位于回流静脉、首次PTA治疗后初级通畅时间短是预后不佳的重要因素,针对上述情况有针对性地采取个体化治疗方案,可能为患者带来更多收益。

Objective To investigate the factors of primary patency time after percutaneous transluminal angioplasty(PTA)in stenotic lesions of autogenous arteriovenous fistula(AVF).Method A total of 202 patients with AVF stenosis who underwent more than two consecutive PTA treatments in the First Affiliated Hospital of Chongqing Medical University from January 2016 to December 2020 were collected.The stenosis location,stenosis length,stenosis degree,and residual stenosis after treatment were measured under digital subtraction angiography(DSA)images of the patients.The risk factors of primary patency time after PTA in patients with AVF stenosis were analyzed.Result At 6 and 12 months after PTA,the primary patency rates of 293 stenotic lesions in 202 AVF patients were 62.3%(126/202)and 23.8%(48/202),respectively.There were no significant differences in primary patency time among different genders,ages,underlying diseases,number of stenoses,stenosis degree,lesion length,and primary patency time of residual stenosis lesions after balloon dilation(P>0.05).There was statistically significant difference in the primary patency time of different stenosis sites(P<0.05).The analysis results of 128 single lesion patients showed that there were statistically significant differences in the patency primary patency time between the proximal anastomotic vein stenosis and the drainage vein stenosis(P<0.05);there were no statistically significant differences in primary patency time between different genders,ages,underlying diseases,stenosis length,stenosis degree,and primary patency time of residual stenosis lesions(P>0.05).Among the 202 patients,59 patients had 3 consecutive PTA treatment records,according to the primary patency time after the first PTA treatment,they were divided into<120 d group(n=20),120-200 d group(n=21),and>200 d group(n=18),the primary patency time after the second PTA was 125.00(88.75,205.75),200.00(122.00,299.00),and 217.00(134.50,412.50)d,respectively,there was statistically significant difference in primary patency time(P<0.05).Conclusion The length and degree of stenosis have no effect on the prognosis of PTA treatment.The location of the lesion in the draining vein and the short primary patency time after the first PTA treatment are important factors for poor prognosis.Targeted and individualized treatment plans for the above situations may bring more benefits to patients.