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| The influencing factors of immature autologous arteriovenous fistula and the clinical effect of ultrasound guided PTA treatment |
| DENG Yuxiong1, LIU Huanhao2, HUANG Libing1, WU Yan1 |
| 1. Ultrasound Medicine Department, 2. Nephrology Department, The People's Hospital of Wuzhou, Wuzhou 543006, China |
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Abstract Objective To explore the influencing factors of poor maturation of autologous arteriovenous fistula and the clinical effect of percutaneous transluminal angioplasty (PTA) treatment under ultrasound. Methods 124 patients with autologous arteriovenous fistula who were planned to undergo autologous arteriovenous fistula treatment in our hospital from August 2022 to July 2023 were selected to observe the occurrence of immature autologous arteriovenous fistula and analyze the clinical data differences between mature and immature patients. Patients with immature autologous arteriovenous fistula were given ultrasound guided PTA treatment to observe the treatment effect. Results Out of 124 patients, 32 had immature autologous arteriovenous fistula, incidence rate was 25.81%. The proportion of hypertension, diabetes and cardiovascular and cerebrovascular diseases in patients with immature autogenous arteriovenous fistula was 56.25%, 40.63% and 46.88%, respectively, which was significantly higher than that in patients with mature autogenous arteriovenous fistula. The diameter of the cephalic vein, the diameter of the posterior cephalic vein, and the diameter of the radial artery in patients with immature autologous arteriovenous fistula were (2.79±0.43) mm, (2.49±0.56) mm, and (3.37±0.61) mm, respectively, which were significantly smaller than those in mature autologous arteriovenous fistula patients, while the total cholesterol (TC) was (4.82±0.91) mmol/L, which was significantly higher than those in mature autologous arteriovenous fistula patients. Logistic regression analysis showed that hypertension, diabetes, the diameter of cephalic vein and radial artery were the influencing factors for the immature autogenous arteriovenous fistula, The model predicts that the area under the ROC curve for immature autologous arteriovenous fistula was 0.836(95% CI: 0.755-0.917), with predictive sensitivity and specificity was 81.30% and 76.30%, respectively, Patients with immature autologous arteriovenous fistulas were successfully treated with ultrasound guided PTA, with a maturation rate of 87.50% (28/32) at 1 monthaftersurgery. The blood flow, fistula vein diameter, and vascular wall thickness at 1months after surgery were (803.32±52.03) ml/min, (6.15±0.90) mm, and (0.73±0.18) mm, respectively, which were significantly increased compared to before surgery. Conclusion The immaturity of autogenous arteriovenous fistula is affected by hypertension, diabetes, the diameter of cephalic vein and radial artery. PTA under ultrasound has a good clinical effect on the immaturity of autogenous arteriovenous fistula, which is worthy of clinical use.
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Received: 24 October 2023
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[1] 卢文文, 黄碧红, 袁立, 等. 自体动静脉内瘘初次通畅时间生存分析和影响因素的前瞻性研究[J]. 复旦学报 (医学版), 2023, 50(2): 249-254.
[2] DU J, KONG XL, LIANG LM, et al.Plasma D-Dimer Level and the Failure of Forearm Autologous Arteriovenous Fistula in Patients With End-Stage Renal Disease[J]. Ther Apher Dial, 2020, 24(4): 400-407.
[3] 代恩, 何小勤, 杨敏, 等. 超声导引经皮腔内血管成形术治疗自体动静脉内瘘狭窄的效果[J]. 介入放射学杂志, 2023, 32(3): 258-261.
[4] 倪其泓, 赵意平, 吕磊, 等. 超声引导下经皮腔内血管成形术治疗动静脉瘘成熟不良的日间模式与临床疗效[J]. 中华医学杂志, 2021, 101(6): 416-420.
[5] 窦斌立. 超声引导下经皮腔内血管成形术治疗动静脉内瘘狭窄的临床观察[J]. 中国药物与临床, 2020, 20(10): 1696-1697.
[6] 金其庄, 王玉柱, 叶朝阳, 等. 中国血液透析用血管通路专家共识 (第2版)[J]. 中国血液净化, 2019, 18(6): 365-381.
[7] LIAO JL, WANG SK, DALSING MC, et al.Endovascular Treatment of a Persistent Traumatic Deep Femoral Arteriovenous Fistula After Gunshot Injury[J]. Vasc Endovascular Surg, 2020, 54(5): 441-444.
[8] OCHIAI S, MINAKAWA A, FUKUDA A, et al.Dural arteriovenous fistula following cerebral venous sinus thrombosis in a patient with minimal change disease: A case report[J]. Clin Nephrol, 2021, 96(6): 348-352.
[9] 史珂慧, 严森辉, 党喜龙, 等. 超声下经皮腔内血管成形术治疗自体动静脉内瘘成熟不良[J]. 肾脏病与透析肾移植杂志, 2023, 32(1): 21-26.
[10] CLARENCON F, SHOTAR E, POUVELLE A, et al.Direct puncture of the superficial temporal artery for ethylene vinyl alcohol embolization of a type 3 arteriovenous fistula with a dual lumen balloon[J]. J Neurointerv Surg, 2021, 13(5): 493.
[11] NISHIMURA S, MURAKAMI T, FUJII H, et al.Unilateral Lower Extremity Edema and Lymphorrhea as Manifestations of a Ruptured Iliac Artery Aneurysm and Arteriovenous Fistula[J]. Ann Thorac Cardiovasc Surg, 2020, 26(4): 216-219.
[12] 汪朋瑞, 陈华茜. 自体动静脉内瘘成熟不良影响因素的研究进展[J]. 临床肾脏病杂志, 2023, 23(7): 585-589.
[13] 王晗, 倪其泓, 王预立, 等. 自体动静脉内瘘成熟影响因素及机制研究进展[J]. 中华普通外科杂志, 2021, 36(1): 71-74.
[14] SRINIVASAN VM, CATAPANO JS, FRISOLI FA, et al.Microsurgical Management of a Marginal Sinus Dural Arteriovenous Fistula: 2-Dimensional Operative Video[J]. Oper Neurosurg, 2021, 21(5): E447-E448.
[15] DAHLERUS C, KIM SH, CHEN S, et al.Arteriovenous Fistula Use in the United States and Dialysis Facility-Level Comorbidity Burden[J]. Am J Kidney Dis, 2020, 75(6): 879-886.
[16] 周文静, 叶红, 吴限, 等. 经皮腔内血管成形术用于动静脉内瘘促成熟治疗的效果及术后初级通畅时间的影响因素分析[J]. 中国医药, 2021, 16(8): 1223-1226.
[17] 惠鑫, 卞雪芹, 丁昊, 等. 基层医院维持性血液透析患者血管通路使用现状调查[J]. 中国血液净化, 2024, 23(2): 138-142.
[18] 史珂慧, 党喜龙, 严森辉, 等. 日间手术模式开展超声下血液透析血管通路介入治疗效果评价[J]. 中华肾脏病杂志, 2021, 37(12): 945-950.
[19] HONG JH.Reduction of Excessive Arteriovenous Fistula Flow Using a Stent Graft[J]. Vasc Endovascular Surg, 2021, 55(2): 189-191.
[20] 王沛, 刘章锁. “以患者为中心”整合诊疗模式在血液透析血管通路临床实践中的应用[J]. 中华肾脏病杂志, 2023, 39(5): 325-329.
[21] 刘坤, 张策, 陈军, 等. 经皮腔内血管成形术在血液透析患者动静脉内瘘血管狭窄中的应用[J]. 血管与腔内血管外科杂志, 2020, 6(3): 202-206, 237.
[22] 魏岁姣, 焦晶, 柏明, 等. 使用动静脉内瘘行维持性血液透析患者接受连续肾脏替代治疗时血管通路选择的研究进展[J]. 临床肾脏病杂志, 2023, 23(9): 760-763.
[23] 赵晔, 王秀颖, 张浩东. 不同血管通路血液透析患者透析充分性及并发症的比较[J]. 内蒙古医科大学学报, 2022, 44(6): 594-597.
[24] 高婉仪, 曾永威, 陈思念. 超声引导下PTA治疗慢性肾衰竭患者动静脉内瘘狭窄疗效的影响因素分析[J]. 江苏医药, 2020, 46(12): 1267-1270. |
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2024, Vol. 21 
