Ultrasound Balloon-guided Ultrasound-guided PTA For The Treatment Of AVF Stenosis

Objective: To observe the therapeutic effect of ultra-high pressure balloon on ultrasound-guided percutaneous transluminal angioplasty(PTA)treatment of arteriovenous fistula(AVF)stenosis in hemodialysis patients,to study the influencing factors of early recurrence after PTA;and analyzing the situation of the first-stage patency rate and the second-stage patency rate after operation,and discussing the influence factors.Methods: This study is a retrospective study.Selecting patients from October 2018 to October 2019 who due to AVF stenosis of Nephrology hospitalized in Guangxi Zhuang Autonomous Region People’s Hospital,and ultrasound-guiding application of ultra-high pressure balloon line in hemodialysis patients under the PTA,collecting general clinical data,laboratory examinations and ultrasound evaluation of internal fistula blood vessels before surgery.To compare the difference of blood vessel diameter and flow rate of internal fistula stenosis before and after PTA treatment by paired t test;Following-up for at least half a year after surgery,from October 2018 to April 2020,to understand the early recurrence,use binary logistic regression analysis to analyze the related factors that affect the early recurrence after PTA;During the follow-up period,the first-stage patency rate and the second-stage patency rate were recorded.Graph Pad Prism was used to plot the cumulative first-stage patency rate and cumulative second-stage patency rate curve of postoperative patients.The single-factor log-rank test and the multi-factor Cox risk proportional regression method were used.Analyze the factors affecting the patency rate of the first phase and the patency rate of the second phase.Result:1.One of the 41 patients had failed surgery,and the success rate of PTA surgery with ultra-high pressure balloon was 97.6%;2.The diameter of the blood vessel,the flow rate of the internal fistula and the flow of the internal fistula after the PTA are significantly increased compared with those before the operation,and the differences are statistically significant(P<0.05);3.The early recurrence rate after ultra-high pressure balloon PTA operation was 20%(8/40),and the early recurrence after ultra-high pressure balloon PTA was positively correlated with the history of diabetes(r = 0.357)and the number of balloon dilatations(r=0.560),Negatively correlated with postoperative fistula flow(r =-0.328),the difference was statistically significant(P<0.05);4.P<0.2 in the univariate analysis was included in the binary logistic model,the results showed that diabetes(B=2.408,OR=11.110,95% CI 1.243-99.292),the number of balloon dilations≥three times(B=3.316,OR=27.564,95% CI2.218-342.519)is an independent influencing factor of early recurrence after ultra-high pressure balloon PTA;5.The first-stage patency rates of 1 month,3 months,and 6 months after PTA application of ultra-high pressure balloon are 97.5%,90.0%,and 80.0%;1month,3 months,and 6 months The patency rates of the second phase are 100%,95.0% and 87.5% respectively;6.The results of single factor log-rank test showed that the postoperative patency rate and the number of balloon dilations were≥ three times(log-rank =4.298,P=0.038),ALB <30g/L(log-rank=4.851,P=0.028)There is a significant correlation;the postoperative second-stage patency rate is significantly correlated with postoperative fistula flow <500ml / min(log-rank=3.907,P=0.048);7.The variable P<0.2 in the log-rank test was included in the multivariate Cox regression analysis.The results showed that the number of balloon expansions was ≥three times(B=1.240,HR=3.455,95% CI 1.131-10.588),which affected the PTA operation.The risk factors of patency rate in the latter period were statistically significant(P<0.05);Postoperative fistula flow rate<500ml/min(B=4.009,HR=55.079,95%CI 3.751-808.700)、balloon dilation≥three times(B=2.013,HR=7.488,95%CI1.837-30.516)is a risk factor that affects the second-stage patency rate after PTA,and the difference is statistically significant(P<0.05).Conclusion:1.Ultrasound-guided ultrasound-guided PTA is an effective method to solve AVF stenosis,but the early recurrence rate is higher;2.Diabetes and balloon dilation ≥ three times are the independent influencing factors of early recurrence after ultra-high pressure balloon PTA;3.The number of balloon dilations ≥ three times is an independent risk factor that affects the patency rate of the first stage after PTA;4.The postoperative fistula flow rate <500ml/min and the number of balloon dilations ≥three times are independent risk factors that affect the second-stage patency rate after PTA.