外周切割球囊治疗动静脉内瘘长段狭窄的疗效及治疗后再狭窄的影响因素

Efficacy of peripheral cutting balloon in the treatment of long stenosis of arteriovenous fistula and influencing factors of restenosis after treatment

目的评估外周切割球囊(peripheral cutting balloon,PCB)治疗动静脉内瘘(内瘘)长段狭窄的有效性和安全性,并初步探讨PCB治疗后再狭窄的影响因素。方法该研究为单中心回顾性研究,纳入2021年8—11月于北京大学第三医院海淀院区因内瘘狭窄(狭窄长度>2 cm)接受PCB进行经皮腔内血管成形术(percutaneous transluminal angioplasty,PTA)治疗的患者。收集和分析患者的临床资料及PTA术后相关随访资料,统计PTA术后3、6、12个月的内瘘初级通畅率及初级辅助通畅率。采用Kaplan-Meier法绘制内瘘初级通畅率的生存曲线,Log-rank检验比较两组间内瘘初级通畅率的差异。采用多因素Cox回归分析法分析PCB治疗后内瘘再狭窄的影响因素。结果该研究共纳入65例患者,年龄为(62.57±11.55)岁,男性42例(64.62%),自体动静脉内瘘61例(93.85%),移植物动静脉内瘘4例(6.15%)。PCB治疗后内瘘狭窄最窄处内径(t=-41.731,P<0.001)、肱动脉血流量(t=-12.510,P<0.001)均显著高于治疗前,治疗后内瘘阻力指数显著低于治疗前(t=9.241,P<0.001)。PTA术后技术成功率为100%(65/65),临床成功率为96.92%(63/65);2例患者在PTA术后未能顺利完成血液透析,但均无相关严重并发症发生。随访时间为12(7,13)个月。12个月内24例(36.92%)出现内瘘功能障碍。Kaplan-Meier生存分析结果显示,PCB治疗后3、6、12个月的内瘘初级通畅率分别为90.77%、81.54%和63.08%,12个月的初级辅助通畅率为100%。PCB治疗后12个月内内瘘狭窄病变长度<36 mm患者的初级通畅率显著高于病变长度≥36 mm患者(Log-rankχ^(2)=6.007,P=0.014)。多因素Cox风险回归分析结果显示,病变长度增加是PCB治疗后12个月内内瘘再狭窄的独立影响因素(HR=1.022,95%CI 1.001~1.045,P=0.042)。结论PCB治疗内瘘相关长段狭窄安全、有效。病变长度增加是PCB治疗后内瘘再狭窄的独立影响因素。

Objective To investigate the efficacy and safety of peripheral cutting balloon(PCB)in the treatment of long stenosis of arteriovenous fistula,and to explore the influencing factors of restenosis after PCB treatment.Methods It was a single-center retrospective study.The patients with long stenosis(>2 cm)of arteriovenous fistula who received PCB treatment of percutaneous transluminal angioplasty(PTA)in Haidian Hospital,the Third Hospital of Peking University from August to November 2021.The clinical and follow-up data after PTA operation were collected and analyzed,and the primary patency rate and primary assist patency rate of fistula at 3,6 and 12 months after PTA operation were calculated.Kaplan‐Meier method was used to draw the survival curve of the primary patency rate of fistula,and log-rank test was used to compare the differences of primary patency rates of fistula between two groups.Multivariate Cox regression analysis was used to analyze the influencing factors of fistula restenosis after PCB treatment.Results A total of 65 patients aged(62.57±11.55)years old were included in this study,including 42 males(64.62%),61(93.85%)autologous arteriovenous fistula and 4(6.15%)arteriovenous graft.The narrowest diameter of fistula stenosis(t=-41.731,P<0.001)and brachial artery blood flow(t=-12.510,P<0.001)after PCB treatment were significantly higher than those before PCB treatment.The resistance index of fistula after PCB treatment was significantly lower than that before PCB treatment(t=9.241,P<0.001).The technical success rate of PTA was 100%(65/65),and the clinical success rate of PTA was 96.92%(63/65).Only 2 patients failed to complete hemodialysis after PCB treatment,and no serious postoperative complications occurred.The follow-up time was 12(7,13)months.Fistula dysfunction occurred in 24 patients(36.92%)within 12 months.Kaplan‐Meier survival analysis showed that the primary patency rates were 90.77%,81.54%and 63.08%at 3,6,and 12 months,respectively,and the primary assist patency rate at 12 months was 100%(65/65).The risk of fistula restenosis in patients with long stenosis≥36 mm was significantly higher than that in patients with long stenosis<36 mm(log-rankχ^(2)=6.007,P=0.014).Multivariate Cox regression analysis showed that increased stenosis length(HR=1.022,95%CI 1.001-1.045,P=0.042)was an independent influencing factor of fistula restenosis within 12 months after PCB treatment.Conclusions PCB is safe and effective in the treatment of long segment stenosis associated with fistula.The increased stenosis length is an independent influencing factor of restenosis in fistula after PCB treatment.