超声引导下PTA开通内瘘血栓性闭塞失败的影响因素分析

Influence Factors of Failure to Open Thrombotic Occlusion of Internal Fistula in Ultrasound-Guided Percutaneous Transluminal Angioplasty

目的:探讨超声引导下经皮腔内血管成形术(PTA)开通内瘘血栓性闭塞失败的影响因素。方法:回顾性选取2020年1月—2023年10月在宜昌市中心人民医院就诊的173例动静脉内瘘血栓性闭塞患者。所有患者均接受超声引导下PTA治疗,根据内瘘血栓性闭塞是否开通成功分为成功组和失败组。比较两组患者一般资料,并采用多因素Logistic回归分析内瘘血栓性闭塞开通失败的影响因素。绘制受试者工作特性曲线(ROC),分析各因素对内瘘血栓性闭塞开通失败的预测价值。结果:在入组的173例患者中,超声引导下PTA开通内瘘血栓性闭塞的成功率为77.46%(134/173)。成功组和失败组患者的年龄、糖尿病、闭塞位置、闭塞长度、内瘘使用时长、闭塞位置是否钙化、血红蛋白水平比较差异有统计学意义(均P<0.05)。多因素Logistic回归分析显示,闭塞位于吻合口段(OR=6.322,95%CI:1.689,23.162)、闭塞长度≥3 cm(OR=3.087,95%CI:1.403,6.786)及闭塞位置钙化(OR=6.605,95%CI:1.159,38.304)是超声引导下PTA开通内瘘血栓性闭塞失败的影响因素(均P<0.05)。ROC曲线分析显示,闭塞位于吻合口段(AUC=0.889)、闭塞长度≥3 cm(AUC=0.861)及闭塞位置钙化(AUC=0.738)对PTA开通内瘘血栓性闭塞失败均具有显著的预测价值。结论:闭塞位于吻合口段、闭塞长度≥3 cm及闭塞位置钙化是超声引导下PTA开通内瘘血栓性闭塞失败的独立影响因素。

Objective:To investigate the influence factors of failure to open thrombotic occlusion of internal fistula in ultrasound-guided percutaneous transluminal angioplasty(PTA).Methods:A total of 173 patients with arteriovenous fistula thrombotic occlusion who were treated in Yichang Central People's Hospital from January 2020 to October 2023 were retrospectively selected.All patients received ultrasound-guided PTA treatment,and were divided into the successful group and the failed group according to whether the internal fistula thrombotic occlusion was successfully opened.The general data of the two groups were compared.The influence factors leading to the failure of opening thrombus occlusion of internal fistula were analyzed by multivariate Logistic regression.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of each factor.Results:Among the 173 patients enrolled,the success rate of opening fistula thrombotic occlusion after ultrasound-guided PTA was 77.46%(134/173).There were significant differences in age,diabetes mellitus,occlusion location,occlusion length,length of internal fistula use,calcification at occlusion location and hemoglobin level between the successful group and the failed group(all P<0.05).Multivariate Logistic regression analysis showed that the occlusion at the anastomotic segment(OR=6.322,95%CI:1.689,23.162),occlusion length≥3 cm(OR=3.087,95%CI:1.403,6.786)and the occlusion location calcification(OR=6.605,95%CI:1.159,38.304)were the influential factors of the failure to open fistula thrombotic occlusion in ultrasound-guided PTA(all P<0.05).ROC curve showed that occlusion at the anastomotic segment(AUC=0.889),occlusion length≥3 cm(AUC=0.861)and occlusion location calcification(AUC=0.738)had significant predictive value for the failure of opening intra-fistula thrombotic occlusion in ultrasound-guided PTA.Conclusion:The occlusion at the anastomotic segment,the occlusion length≥3 cm and the occlusion location calcification are independent influencing factors for the failure of opening internal fistula in ultrasound-guided PTA.