| Backgrands and Objective:As China’s aging population increase,some chronic diseases,hypertension,diabetes,hyperlipidemia disease incidence rate is higher and higher,and these diseases are likely to lead to renal abnormalities,seriously can lead to kidney failure,at the same time,the incidence of primary nephrotic also more and more high,these can lead to kidney lesions,eventually lead to end-stage renal disease,need through blood dialysis to sustain life.Hemodialysis pathway is the essential condition of line hemodialysis,regular hemodialysis pathways,including temporary,long-term deep venipuncture,autologous artificial arteriovenous internal fistula,artificial blood vessel arteriovenous internal fistula,etc.,including arteriovenous internal fistula is most widely used,is also the most optimal path choice,has a long service life,blood flow is big,fewer complications,etc.But with the increase of number of dialysis,the blood vessels of repeated puncture,intimal hyperplasia and thrombus formation cause of vascular lumen stenosis or occlusion,traditional commonly used surgical approach,diseased blood vessels,colostomy,the line end to end anastomosis or directly from the new interventional surgery in recent years,the mature and are involved in the development of consumables,Percutaneous puncture angioplasty(Percutaneous transluminal angioplasty,PTA)been tried for the treatment of arteriovenous internal fistula,narrow application interventional surgery to expand or narrow blood vessels or occluded lesion reascularization.This study is mainly to study and analyze the clinical efficacy of percutaneous selective balloon dilatation for autologous artificial arteriovenous internal fistula stenosis and analyze the factors influencing the patency rate after surgery,summarize experience,improve the success rate of surgery and extend the use time.Methods:Date of 139 patients with arteriovenous internal fistula stenosis treated by percutaneous selective balloon dilatation in our department from September 2017 to September 2019 were collected,and the basic types of stenosis lesions,surgical success rate,postoperative patency rate and postoperative complications were statistically analyzed.The difference between high pressure balloon and common balloon in the treatment of arteriovenous internal fistula stenosis was compared,andthe advantages of ultrasound-guided balloon dilatation were analyzed.Results:1.In this study,139 patients,including 86 males and 53 females,met the inclusion and exclusion criteria.The average age was 61.31 ± 13.68 years.The establishment time of internal fistula was 1-120 months,and the average use time was18.91 ± 22.85 months.The longest dialysis time was 112 months before the establishment of internal fistula.Minimum 0 months;The mean time was 6.50±12.53 months.2.The angiographic results of 139 cases showed that 77.70% of the patients were located at the fistula and venous stenosis.Simple arterial segment stenosis accounted for 2.88%.Vascular stenosis at the puncture site accounted for 4.32%.Deep vein stenosis accounted for 4.32%;Mixed stenosis accounted for 10.78%.3.Intraoperative approaches were: cephalic vein(114/139),brachial artery(15/139),femoral vein(2/139),and multiple approaches(8/139).The number of scabbard implantation was generally 1,but there were also 8 patients who received 2scabbard implantation during the operation.Among them,2 patients received scabbard implantation in the femoral vein and the cephalic vein of the upper arm,and1 patient received stent implantation after PTA.The remaining 6 patients were all of high intraoperative difficulty,and were sheathed in brachial artery and cephalic vein respectively.4.Among the 139 cases,129 patients were successful and 10 failed,with a success rate of 92.81%.The average operation time was 58.55±12.71 minutes.The incidence of postoperative complications was 9.36%.The patency rates of AVF at 3months,6 months and 12 months respectively 98.45%;83.72% and 68.22%.5.There were 78 cases in the high-pressure balloon group and 61 cases in the conventional balloon group.The technical success rate of the two groups was 95.08%and 91.02%,respectively(P=0.358).On average,1.10±0.30 balloons were used in the high-pressure balloon group and 1.86±0.39 balloons in the conventional balloon group(P < 0.01).On average,the operation time was 49.79±10.43 minutes in the high-pressure balloon group and 65.40 ± 9.82 minutes in the conventional balloon group(P < 0.01).The patency rates of the two groups were 77.46% and 91.3%(P=0.033)at 6 months ’follow-up,respectively.6.Ten patients with AVF stenosis were treated with ultrasound-guided PTA,and the single puncture was successful in 9 cases.Cephalic vein approach was used in 8cases,double sheath was inserted in 1 case,cephalic vein and brachial artery approach were used in 1 case,brachial artery approach was used in 1 case.The average operation time was 60.30 ± 10.77 min.No serious complications were found after operation.During postoperative follow-up,only 1 patient developed recurrent stenosis at 3 months.Conclusions:1.PTA operation has the characteristics of high success rate,short operation time and few postoperative complications in the treatment of autologous arteriovenous fistula stenosis.2.PTA approach has many choices.For simple internal fistula,cephalic vein approach can be chosen;for complex internal fistula,brachial artery approach can be chosen;for deep vein stenosis,double approaches of cephalic vein and femoral vein can be chosen.3.Both the high-pressure balloon and the conventional balloon have achieved good results in the treatment of arteriovenous internal fistula stenosis,but the high-pressure balloon can shorten the operation time and the number of the balloon,and the patent rate in the 6-month follow-up is higher than the conventional balloon.4.Ultrasound-guided balloon dilatation is a good choice for the treatment of arteriovenous internal fistula stenosis.It has the advantages of simple surgical site requirements,no X-ray radiation,and real-time blood flow assessment.However,a good solid ultrasound foundation is required for surgeons. |
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