Percutaneous Transluminal Angioplasty Of Arteriovenous Fistula Dysfunction In Hemodialysis Patients

Background and Purpose: Central Venous Stenosis and occlusion(CVD)of dialysis access is a common complication in long-term hemodialysis patients.CVD may reduce fistula flow and result in access recirculation and inadequate dialysis,which may ultimately lead to dialysis access abandonment.Currently,Percutaneous Transluminal Angioplasty(PTA)with or without stent placement is recommended as the preferred treatment for CVD in hemodialysis patients,but there are still some controversies regarding the indications and timing of stent placement in current clinical studies.This study retrospectively analyzed PTA combined with selective Bare Metal Stents(BMS)implantation in treating CVD in hemodialysis patients,and aim to evaluate its safety and efficacy.Materials and Methods: This study was a single center,single arm retrospective study,which analyzed PTA combined with selective BMS implantation in treating CVD in hemodialysis patients in our hospital’s hemodialysis center from 2017 to 2019.Patients with more than 30% of residual stenosis after multiple balloon dilatation were treated with BMS implantation.The end points included technical success,clinical success,primary patency rate of central vein,and secondary patency rate of central vein.A P value of less than 0.05 was considered statistically significant.Results: A total of 48 patients were enrolled in this retrospective study.Four cases failed because the guidewire could not pass through the occlusive lesions in central veins.Twenty-four cases underwent single PTA,and the other 20 cases were implanted with BMS after balloon dilation.The overall technical success rate was 91.7% and the overall clinical success rate was 89.6%.The median follow-up time was 30.0m(1.5-54.0m),and the primary patency rate of the central vein at 6m,12 m,and 24 m was 77.3%,45.5%,15.9%,respectively.The secondary patency rates of the central vein at 12 m and 24 m were 97.8% and 86.4%,respectively.Kaplan-Meier test and Log-rank test indicated that the primary patency rate of PTA combined with BMS was higher than that of PTA alone,and the difference was statistically significant(P < 0.05).Conclusions: PTA combined with selective BMS implantation in treating CVD in hemodialysis patients is safe and effective.Although the primary patency rate is limited,the secondary patency rate is relatively higher under multiple endovascular treatment interventions.Background and Purpose: Autogenous Arteriovenous Fistulas(AVF)and Prosthetic Arteriovenous Fistulas(AVG)have been recommended as the preferred dialysis access by current guidelines.Arteriovenous fistula stenosis and secondary thrombosis are the main complications and the main causes of fistula dysfunction.Percutaneous transluminal angioplasty(PTA)is currently the first-choice therapy for treating arteriovenous fistula dysfunction.Traditionally,interventional therapy is performed under fluoroscopic guidance and ultrasound-guided PTA is frequently used clinically.This study retrospectively analyzed the cases of arteriovenous fistula dysfunction treated by PTA under two guidance methods,and aim to compare their safety and efficacy.Materials and Methods: This clinical study was a multi-center retrospective controlled study,which analyzed the cases of arteriovenous fistula dysfunction treated by X-Ray-guided(XG)or Ultrasonic-guided(UG)PTA in three centers from 2016 to 2018.The primary endpoints were technical success,clinical success,and primary patency rates.The secondary endpoints were complications and secondary patency rates.Procedure outcomes and both endpoints were evaluated by propensity score analysis.Results: According to the inclusion and exclusion criteria,a total of 219 cases were included in this retrospective study.After the propensity score matching,73 matched pairs of cases were created with 34 pairs of autogenous arteriovenous fistula cases and 39 pairs of prosthetic arteriovenous graft cases.There was no significant difference between the X-ray-guided and ultrasound-guided group,respectively,regarding the technical success rate(84.9% vs.87.7%,P>0.05),clinical success rate(98.6% vs.97.3%,P>0.05),and complications(10.9% vs.5.5%,P>0.05).The median followup time was 24.4m(2.0-51.3m).Kaplan-Meier test and Log-Rank test showed that there were no significant differences in primary patency and secondary patency curves of all cases,AVF cases,and AVG cases after PTA in the XG group and UG group(P > 0.05).Conclusions: The overall efficacy and safety of UG PTA in treating arteriovenous fistula dysfunction might be comparable to XG PTA.In the future,these two methods may be combined to deliver more efficient treatment.