Ultrasound guided percutaneous transluminal angioplasty for arteriovenous fistula and graft stenosis -----A 6-years clinical observation

Abstract

Abstract Background: Percutaneous transluminal angioplasty(PTA) is the preferred treatment of vascular stenosis in arteriovenous fistula(AVF) and arteriovenous graft(AVG) in maintenance hemodialysis(MHD) patients. We observed the efficacy and influencing factors of PTA guided by Ultrasound in the treatment of AVF and AVG in our center. Methods: The data of PTA patients under the guidance of Ultrasound in our center from September 2015 to September 2021 were collected. 284 AVF patients and 83 AVG patients met the inclusion criteria, clinical indicators, postoperative use time and patency rate of the two groups were compared, and multiple linear regression analysis was used to compare the factors affecting the postoperative use time of the two groups. Results: The use time before (17.0(3.0, 64.6) vs 10.0(1.0, 27.9)) and after (9.0(2.0, 37.8) vs 6.0(1.0, 24.0)) PTA and high density lipoprotein concentration(1.36±0.36 vs 1.06±0.32) in AVF group were significantly higher than those in AVG group(P<0.05), and fibrinogen(4.03(2.78,6.22) vs 4.7(3.4,6.6)), blood phosphorus(1.33±0.48 vs 1.58±0.39), iPTH(408.15(22.13,1084.91) vs 509.7(83.03,1228.8)), total cholesterol(5.24±1.39 vs 5.64±1.42) and very low density lipoprotein concentration(0.51±0.27 vs 0.69±0.17) in AVF group were significantly lower than those in AVG group. The patency rates at 3, 6, 12, 24 months of AVF patients were 94.7%, 77.1%, 28.5%, 8.5%, and the patency rates at 3, 6, 12, 24 months of AVG patients were 88.0%, 54.2%, 18.1%, 3.6% respectively. Kaplan-meier analysis showed that the postoperative patency rate of AVF was significantly higher than that of AVG(P<0.05). In AVF group, the postoperative use time of PTA was related to primary disease, gender and platelet distribution width(P<0.05), while the postoperative use time of PTA was related to gender and eosinophil in AVG group(P<0.05). Conclusion: PTA guided by Ultrasound can effectively treat AVF/AVG stenosis, which causes minimum surgical trauma and can save precious vascular resources for MHD patients, this procedure is worthy of further promotion in clinical practice.