TITLE: Efficacy of ultrasound-guided percutaneous transluminal angioplasty for arteriovenous fistula stenosis or occlusion at juxta-anastomosis-a three-year follow-up cohort study.

OBJECTIVE: Arteriovenous fistula (AVF) is the preferred access for hemodialysis. Percutaneous transluminal angioplasty(PTA) has become a choice for AVF stenosis and ultrasound has been used in PTA more frequently.

METHODS: This single-center retrospective cohort study analyzed 129 patients who underwent PTA in the First Affiliated Hospital of Chongqing Medical University from January 2016 to December 2016. Angioplasty was performed using a non-compliant high-pressure balloon. The process was visualized by duplex scan. Our inclusion criteria were as follows: (1)stenoses or occlusions were located at the juxta-anastomosis site:the first 5cm of the vein distal to the anastomosis;(2) stenosis was confirmed with the following conditions:(a)flow ratesare <500ml/min in the brachial artery and<200ml/min in the fistula during dialysis, and(b)the stenosis diameter is<1.7mm.We used Kaplan-Meier curve to show the postintervention primary and secondary patency rates of patients with stenosis and occlusion.

RESULTS: Altogether,129 patients with 76 males were analyzed. Moreover,104 have AVFs on left arm,and only one had ulna-basilic AVF, while others had radial-cephalic AVF.The postintervention primary patency rates are better in occlusion cases(P<0.05),while secondary patency rates have no difference.The postintervention primary patency rates are better in patients without diabetes mellitus(P<0.05),while the secondary patency rates had no difference.

CONCLUSION: For juxta-anastomosis site stenosis or occlusion,PTA can be used to obtain satisfactory results.

SOURCE: Gu H, Wan Z, Lai QQ, et al. Efficacy of ultrasound-guided percutaneous transluminal angioplasty for arteriovenous fistula stenosis or occlusion at juxta-anastomosis-a three-year follow-up cohort study[J]. J Vasc Surg, 2020, DOI: 10.1016/j.jvs.2020.11.041.

目的：动静脉内瘘（AVF）是血液透析的首选途径。经皮腔内血管成形术（PTA）已成为AVF狭窄的一种选择，并且超声在PTA中使用频率更高。

方法：该单中心回顾性队列研究分析了2016年1月至2016年12月在重庆医科大学附属第一医院接受PTA治疗的129例患者。使用非顺应性高压球囊进行了血管成形术。通过多普勒扫描使该过程可视化。我们的纳入标准如下：（1）狭窄或闭塞位于吻合口附近：距吻合口5cm内;（2）在以下情况下确认狭窄：（a）肱动脉流量<500ml / min，以及透析流量<200ml / min，（b）狭窄直径<1.7mm。我们使用Kaplan-Meier曲线显示狭窄和闭塞患者的干预后一期和二期通畅率。

结果：总共分析了129例患者，其中76例为男性。此外，有104例左臂AVF，仅1例为尺-贵要型AVF，其余为桡-头型AVF。闭塞病例的介入后一期通畅率更高（P <0.05），而二次通畅率无差异。无糖尿病患者的干预后一期通畅率更高（P <0.05），而二次通畅率无差异。

结论：对于近吻合口狭窄或闭塞，PTA可取得满意的效果。

启发：近吻合口的狭窄和闭塞的处理有两种方式，一种为介入PTA，另一种为开放重造，PTA可取得满意的效果，但仍需从整体获益情况，来选择个体化的治疗方案。