腕部内瘘吻合口旁狭窄经皮腔内血管成形术后复发的危险因素分析:一项单中心前瞻性队列研究

Analysis of the risk factors for recurrence of juxta-anastomotic stenosis in wrist arteriovenous fistula after percutaneous transluminal angioplasty:a single-center prospective cohort study

目的分析腕部桡动脉-头静脉内瘘(radial-cephalic arteriovenous fistula,RC-AVF)吻合口旁狭窄首次经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)后复发的危险因素。方法单中心前瞻性分析2021年1月—2022年6月在浙江中医院大学附属杭州市中医院接受PTA治疗的自体动静脉内瘘(arteriovenous fistulas,AVF)患者,收集患者的一般资料、病变特征、技术因素及辅助检查结果,使用单因素和多因素分析评估PTA后复发的危险因素。结果共纳入120例患者,114例RC-AVFs患者成功完成了首次PTA治疗,手术成功率为95.0%(114/120)。112例患者完成了随访,PTA后90、180、360、540天一期通畅率分别为:94.6%、81.3%、56.1%、33.3%;一期辅助通畅率分别为:97.3%、95.5%、85.1%、70.1%;二期通畅率分别为:100%、100%、95.7%、85.7%。COX回归分析显示球囊直径(HR=0.62,95%CI:0.43~0.89,P=0.009)是PTA手术后一期通畅率丢失的独立预测因素,ROC曲线分析AUC为0.614(95%CI:0.510~0.718,P=0.037),临界值为6.0 mm;狭窄长度(HR=1.04,95%CI:1.02~1.07,P<0.001)、狭窄数量(HR=3.73,95%CI:1.32~10.54,P=0.013)是PTA手术后一期辅助通畅率丢失的独立预测因素,狭窄长度AUC为0.686(95%CI:0.543~0.838,P=0.009),临界值为17.5 mm;狭窄数量AUC为0.685(95%CI:0.559~0.810,P=0.010),临界值为2。结论RC-AVF吻合口旁静脉狭窄首次PTA后的复发率较高,球囊直径与RC-AVF吻合口旁静脉狭窄首次PTA后再狭窄相关,使用最大直径<6 mm的球囊是手术后一期通畅率丢失的独立预测因素。长段狭窄(≥17.5 mm)和多发狭窄(≥2个)是一期辅助通畅率丢失的独立预测因素。

Objective This study aimed to explore the risk factors for restenosis of the juxta-anastomotic stenosis in radial-cephalic arteriovenous fistula(RC-AVF)after primary percutaneous transluminal angioplasty(PTA).Methods A single-center prospective study was conducted,to analyze the patients with arteriovenous fistula(AVF)undergoing PTA treatment between January,2021 and June 2022.Their demographics,lesional characteristics,technical factors,and auxiliary examination results were collected.Risk factors for restenosis after PTA were evaluated using univariate and multivariable analyses.Results A total of 114 patients with RC-AVF successfully completed the first PTA treatment with a technical success rate of 95.0%(114/120),and 112 patients finished follow-up the primary assistant patency time was 512.15±226.32 days,and the secondary patency time was 554.88±205.67 days.After PTA for 90,180,360,and 540 days,the primary patency rates were 94.6%,81.3%,56.1%,and 33.3%,respectively;the primary assistant patency rates were 97.3%,95.5%,85.1%,and 70.1%,respectively;the secondary patency rates were 100%,100%,95.7%,and 85.7%,respectively.Cox regression analysis showed that balloon diameter(HR=0.62,95%CI:0.43~0.89,P=0.009)was the independent predicting factor for primary patency loss after PTA.ROC curve analysis showed an AUC area of 0.614(95%CI:0.510~0.718,P=0.037)and a critical value of 6.0 mm.Stenosis length(HR=1.04,95%CI:1.02~1.07,P<0.001)and stenosis number(HR=3.73,95%CI:1.32~10.54,P=0.013)were the independent predicting factors for primary assistant patency loss after PTA,with AUC areas of 0.686(95%CI:0.543~0.838,P=0.009)and 0.685(95%CI:0.559~0.810,P=0.010),critical values of 17.5 mm and 2.Conclusions Restenosis of the juxta-anastomotic venous stenosis in RC-AVF after primary PTA remains high.Balloon diameter is closely related to the restenosis after PTA.The use of a balloon with a maximum diameter<6 mm is an independent predictor for primary patency loss after PTA.Longer stenosis(≥17.5 mm)and stenosis number≥2 are the independent predictors for primary assistant patency loss after PTA.