TITLE: Factors affecting patency of arteriovenous fistula following first percutaneous transluminal angioplasty

BACKGROUND: Percutaneous transluminal angioplasty (PTA) has generally replaced surgical procedures to treat arteriovenous fistula (AVF) dysfunction, but the predictors of post-intervention patency are highly variable. This study aimed to determine predictors of primary patency following PTA of dysfunctional AVF.

MATERIALS AND METHODS: Retrospective analysis of first-time PTA of 307 AVF in 307 patients (171 males, mean age 64.3 ± 12.4 years). Demographic, clinical, anatomical and medication variables were reviewed and subjected to univariate and multivariate Cox regression analysis.

RESULTS: The post-intervention primary patency rates at 6, 12, 24, and 36 months were 76.3%, 58.3%, 43.2%, and 38.2%, respectively. The higher aortic arch calcification (AAC) grade patients were older, had higher incidence of comorbidities and cardiomegaly, and younger AVF age, but their dialysis vintage term was shorter and diastolic blood pressure was lower, and the maximum diameter of balloon angioplasty was mostly ≤ 6 mm, and had lower phosphorus level and less calcium-containing phosphate binder use. In multivariate Cox proportional hazard analysis, the presence of higher AAC grade [hazard ratio (95% confidence interval): (1.46 (1.02-2.09); p = 0.037)] and stenosis at upper arm [1.76 (1.16-2.67); p = 0.008] were associated with shorter post-intervention primary patency.

CONCLUSION: In conclusion, higher AAC grade and anatomic factor related to the location of AVF (upper arm) were the important predictors of AVF dysfunction after PTA. These results could assist in tailoring surveillance programs and performing appropriate interventions for risky AVF.

SOURCE: Yap YS, Chi WC, Lin CH, et al. Factors affecting patency of arteriovenous fistula following first percutaneous transluminal angioplasty[J]. Clin Exp Nephrol, 2021, 25(1):80-86. DOI: 10.1007/s10157-020-01958-w. 

背景：经皮腔内血管成形术(PTA)已普遍取代外科手术治疗动静脉内瘘(AVF)功能障碍，但预测介入术后再通的指标具有很高的可变性。本研究旨在确定失功动静脉内瘘经皮腔内血管成形术(PTA)后初次通畅率的预测因素。

资料与方法：回顾性分析307例(171例男性，平均年龄64.3±12.4岁)307例AVF患者首次PTA的临床资料。回顾人口统计学、临床、解剖学和药物治疗等变量，并进行单变量和多变量Cox回归分析。

结果：介入治疗后6、12、24、36个月的一次通畅率分别为76.3%、58.3%、43.2%、38.2%。主动脉弓钙化程度高的患者年龄大，合并症和心脏增大的发生率高，动静脉内瘘的年龄小，但透析年限短，舒张压低，球囊成形术最大径多为≤6 mm，磷水平低，含钙磷酸盐结合剂使用量少。在多变量Cox比例风险分析中，AAC分级较高[危险比(95%可信区间)：(1.46(1.02-2.09)；p=0.037)]和上臂狭窄[1.76(1.16-2.67)；p=0.008]与介入后较短的初次通畅有关。

结论：较高的AAC分级和与AVF(上臂)位置相关的解剖因素是PTA术后AVF功能障碍的重要预测因素。这些结果可能有助于定制监测计划，并对有风险的动静脉内瘘进行适当的干预。

启发：1.主动脉弓钙化评分可体现血管钙化情况，反映血管条件，钙化重的PTA后血管初次通畅率更低；2.上臂AVF的血流动力学不同于前臂，通畅率是否与较高的血流量、剪切力、内膜增生程度有关，还有待进一步研究。