目的: 通过对比前臂自体动静脉内瘘（arteriovenous fistula,AVF）狭窄经皮腔内血管成形术（percutaneous transluminal angioplasty,PTA）治疗后的通畅情况,探讨高频超声PTA对于透析通路狭窄的治疗效果及影响术后通路率相关因素。方法: 选取北京核工业医院和首都医科大学附属友谊医院血液透析中心2022年2月—2024年2月收治的前臂AVF狭窄患者134例,依据狭窄部位分为四组,其中Ⅰ型狭窄（n=45）、Ⅱ型狭窄（n=43）、Ⅲ型狭窄（n=21）与Ⅳ型狭窄（n=25）,四组患者均在超声引导下进行PTA治疗。收集患者基线资料（年龄、性别、基础疾病等）及通路特征（吻合角度、穿刺方式、血流量等）,采用多因素Logistic回归模型分析影响术后通畅率的独立危险因素。结果: Ⅰ、Ⅱ、Ⅲ型AVF狭窄患者通路使用时长有显著差异（Ⅰ型<Ⅱ型<Ⅲ型）,Ⅰ型狭窄通路使用时间最短,平均为1.48年,Ⅲ型狭窄通路使用时间最长,平均为6.65年。四组患者PTA治疗术后,狭窄内径、肱动脉血流量均较术前明显升高,四组患者术后1个月、3个月、6个月血管通畅率比较,差异均无统计学意义（P>0.05）;四组患者术后9个月的血管通畅率比较,差异有统计学意义,Ⅱ型狭窄和Ⅳ型狭窄之间差异最明显。术后通畅情况再次纳入多因素Logistic回归分析,吻合角度是Ⅰ型狭窄危险因素（OR=3.525,P<0.05）、穿刺方式是Ⅱ型狭窄危险因素（OR=2.151,P<0.05）、血流量是Ⅲ型狭窄危险因素（OR=2.238,P<0.05）、糖尿病是Ⅳ型狭窄危险因素（OR=2.808,P<0.05）。结论: 高频超声引导PTA对四型前臂动静脉内瘘狭窄均具有显著疗效,狭窄类型、吻合角度、穿刺方式以及糖尿病等因素影响术后通畅率。
Abstract
Objective To compare the patency outcomes of percutaneous transluminal angioplasty (PTA) in patients with forearm arteriovenous fistula (AVF) stenosis and investigate the efficacy of high-frequency ultrasound-guided PTA and prognostic factors influencing post-operative patency. Methods A total of 134 patients with forearm AVF stenosis treated at the Blood Purification Center of Beijing Nuclear Industry Hospital and Friendship Hospital of Capital Medical University from June 2022 to February 2024 were retrospectively analyzed. Patients were classified into four groups based on stenosis location: Type I (n=45, anastomotic stenosis), Type II (n=43, venous outflow stenosis), Type III (n=21, mixed stenosis), and Type IV (n=25, venous valve stenosis). All patients underwent ultrasound-guided PTA. Collect baseline patient data (age, gender, underlying diseases, etc. ) and pathway characteristics (anastomosis angle, puncture method, blood flow, etc. ), and use a multivariable Logistic regression model to analyze the independent risk factors affecting postoperative patency rates. Results Significant differences were observed in access usage duration among groups (Type I<Type II<Type III), with the shortest (1.48 years) in Type I and longest (6.65 years) in Type III. Post-PTA, residual stenosis diameter and brachial artery blood flow significantly improved in all groups. No intergroup differences in 1-, 3-, and 6-month patency rates were found, but 9-month patency rates differed significantly, with the most pronounced difference between Type II and Type IV. Multivariate Cox regression identified anastomotic angle<30°(OR=3.525, P<0.05), regional puncture (OR=2.151, P<0.05), blood flow>3 000 mL/min (OR=2.238, P<0.05), and diabetes mellitus (OR=2.808, P<0.05) as independent risk factors for Type I-IV stenosis, respectively. Conclusion High-frequency ultrasound-guided PTA effectively treats forearm AVF stenosis across all four types. Stenosis classification, anastomotic angle, puncture technique, and diabetes mellitus are critical determinants of post-operative patency.
关键词
彩色多普勒超声 /
自体动静脉内瘘 /
经皮腔内血管成形 /
通畅率
Key words
color doppler ultrasonography /
arteriovenous fistula /
percutaneous transluminal angioplasty /
patency rate
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基金
北京市医院管理中心青苗计划 “基于光声断层成像的外周血管疾病智能诊断设备研发及原型机验证”（2024YFC2421800）
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