血透患者小直径动脉经皮腔内血管成形术后行动静脉内瘘术的疗效

Effect of percutaneous transluminal angioplasty prior to arteriovenous fistula creation for small-diameter artery in hemodialysis patients

目的探讨血液透析患者小直径动脉经皮腔内血管成形术(PTA)后行动静脉内瘘(AVF)术的疗效。方法本研究为单中心前瞻性队列研究。纳入2021年6月1日至2023年6月1日在贵州医科大学附属肿瘤医院肾脏内科建立长期血液透析通路、并且前臂小动脉(桡动脉或尺动脉)直径<1.5 mm的108例终末期肾脏病(ESRD)患者。其中,76例患者在PTA后行AVF成形术(PTA+AVF组),32例患者作为对照行AVF成形术(AVF组)。收集患者的一般信息,PTA术中和术后的相关资料,AVF成形术后的肱动脉、桡动脉、尺动脉、头静脉、贵要静脉的直径和血流指标,以及内瘘成熟情况的指标,并进行统计分析。结果PTA+AVF组患者PTA术后的即刻桡/尺动脉直径及收缩期峰值流速(PSV)均高于PTA术前(t=-10.644,P<0.01;t=-6.386,P<0.001);PTA术后1 d的桡/尺动脉直径及PSV亦高于PTA术前(t=-10.645,P<0.01;t=-6.388,P<0.001);而PTA术后即刻与术后1 d的桡/尺动脉直径及PSV之间无明显差异(t=-0.129,P=0.897;t=0.571,P=0.569)。AVF成形术后4周、8周、12周,PTA+AVF组患者的肱动脉血流量、头/贵要静脉直径、桡/尺动脉直径均大于AVF组(P<0.05)。AVF成形术后4周、8周、12周,PTA+AVF组患者的内瘘成熟率分别为22.97%(17/74例)、81.08%(60/74例)、93.24%(69/74例),而AVF组患者的内瘘成熟率则分别为6.25%(2/32例),33.33%(9/27例),42.31%(11/26例),PTA+AVF组的内瘘成熟率均高于AVF组(χ2=4.247,P<0.05;χ2=20.836,P<0.001;χ2=31.198,P<0.001)。结论血液透析患者小直径动脉PTA术后行AVF成形术,可以获得良好的AVF成熟率,该方式可以成为有效利用患者前臂小直径动脉资源的策略之一。

Objective The study aimed to investigate the efficacy of percutaneous transluminal angioplasty(PTA)prior to arteriovenous fistula(AVF)creation for small-diameter artery in hemodialysis patients.Methods This study was a single-center prospective cohort study.A total of 108 patients with end-stage renal disease(ESRD)to establish long-term hemodialysis access,whose forearm small artery(radius or ulnar artery)was<1.5 mm in diameter,were enrolled from the Department of Nephrology,Cancer Hospital Affiliated to Guizhou Medical University from June 1,2021 to June 1,2023.Among them,76 patients underwent AVF creation after PTA(PTA+AVF group),while 32 patients underwent only AVF creation as control(AVF group).All the patients&apos;general information,relevant data during and after PTA,and diameters and blood flow indicators of brachial artery,ulnar artery,radial artery,cephalic vein,and basilic vein,as well fistula maturation indicators after AVF creation.The differences between the two groups were then statistically analyzed.Results The radial/ulnar artery diameter and the peak systolic velocity(PSV)immediately after PTA in the PTA+AVF group were higher than those before PTA(t=-10.644,P<0.01;t=-6.386,P<0.001).The radial/ulnar artery diameter and PSV at 1 day after PTA were also higher than those before PTA(t=-10.645,P<0.01;t=-6.388,P<0.00).However,there were no significant differences between the radial/ulnar artery diameter and PSV immediately after PTA and those at 1 day after PTA(t=-0.129,P=0.897;t=0.571,P=0.569).At 4,8,and 12 weeks after AVF creation,the blood flow volume of brachial artery and diameters of cephalic/basilic vein and radial/ulnar artery of the PTA+AVF group were all higher than those of the AVF group(P<0.05).And at 4,8,and 12 weeks after AVF,the fistula maturation rates of the PTA+AVF group were 22.97%(17/74 cases),81.08%(60/74 cases),and 93.24%(69/74 cases),respectively,while those in the AVF group were 6.25%(2/32 cases),33.33%(9/27 cases),and 42.31%(11/26 cases),respectively.In the PTA+AVF group,the fistula maturation rates at 4,8,and 12 weeks after AVF were higher than those in the AVF group(χ2=4.247,P<0.05;χ2=20.836,P<0.001;χ2=31.198,P<0.001).Conclusion A good AVF maturation rate could be obtained by AVF creation after PTA for the small-diameter arteries of the hemodialysis patients,which may be one of the strategies to effectively utilize the resources of small-diameter arteries of the patients&apos;forearms.