Clinical Application Of Interventional Treatment Of Stenosis Of Arteriovenous Fistula By Distal Radial Artery

Background: At present,the aging state of our society is becoming more and more serious,and with the acceleration of the rhythm of social life in our country,and the young and middle-aged groups in our country are in the environment of tension and high pressure for a long time,the risk of end-stage renal disease is increased,it gradually becomes a major disease threatening the health of our country.At present,one of the main methods for the treatment of end-stage renal disease is maintenance hemodialysis,maintenance hemodialysis needs to establish arteriovenous fistula,and the important premise of successful completion of hemodialysis is to ensure the smooth flow of arteriovenous fistula.Because arteriovenous fistula has the advantages of low incidence of vascular stenosis,thrombosis,infection and other complications,repeatable puncture,spontaneous healing,long service cycle and so on,it has become the first choice of long-term vascular pathway.However,with the prolongation of the use time of arteriovenous fistula in hemodialysis patients,infection,intimal hyperplasia,thrombus and other complications gradually appeared,which eventually led to the stenosis of arteriovenous fistula and the decrease of dialysis blood flow,which was one of the main causes of hemodialysis failure.Therefore,it is necessary to solve the problem of maintaining hemodialysis by avoiding stenosis and maintaining unobstructed vascular pathway.In recent years,percutaneous transluminal angioplasty is the main choice for the treatment of arteriovenous fistula stenosis.The use of percutaneous transluminal angioplasty prolongs the service cycle of arteriovenous fistula and reduces the chance of reoperation of arteriovenous fistula.There are many approaches to percutaneous transluminal angioplasty.The main direction of this paper is to treat autologous arteriovenous fistula stenosis by percutaneous angioplasty through distal radial artery path.Interventional therapy through distal radial artery pathway is a safe and feasible new treatment technique and supplementary method for arteriovenous fistula stenosis.The interventional operation through the distal radial artery path is reproducible,can detect the blood flow of arteriovenous fistula in time,can be used immediately after operation,the postoperative recovery is fast and the complications are few,and the stenosis of arteriovenous fistula can be solved in time and effectively,thus prolonging the service cycle of arteriovenous fistula.Objective: To investigate the safety and effectiveness of interventional treatment of arteriovenous fistula by distal radial artery pathway,and to compare the interventional treatment of arteriovenous fistula by cephalic vein,radial artery and distal radial artery.Methods: From January 2019 to December 2019,135 patients with arteriovenous fistula stenosis were treated with percutaneous transluminal angioplasty,the arteriovenous fistula was located in the forearm,the anastomosis was the end-side anastomosis of radial artery head vein and the first arteriovenous fistula stenosis.The patients were randomly divided into three groups according to hospitalization number,according to different puncture paths,the patients were divided into cephalic vein group,radial artery group and distal radial artery group.Results:1.There were 135 patients with arteriovenous fistula stenosis,including 73 men and 62 women,aged between 40 and 76 years,with an average age of(60.8 ±1.8)years.The primary diseases were: 67 cases of chronic nephritis,39 cases of diabetic nephropathy and 29 cases of hypertensive nephropathy.The arteriovenous fistula was located in the forearm,and the anastomosis of the arteriovenous fistula was the end-side anastomosis of the radial artery cephalic vein,the patients were included in the first arteriovenous fistula stenosis.2.There was no significant difference in baseline level between cephalic vein group,radial artery group and distal radial artery group(P > 0.05).3.The success rate of tube placement was 95.56% in the cephalic vein group,the radial artery group was 93.33%,the distal radial artery group was 88.89%;The incidence of postoperative complications was 33.33% in radial artery group,the cephalic vein group was 17.78%,the distal radial artery group was 11.11%;Immediate blood flow after stenosis was(525.22 ± 15.76)ml/min in radial artery group,the cephalic vein group was(553.89 ± 10.13)ml/min,the distal radial artery group was(553.56 ± 15.18 ml/min).4.There was no difference in the success rate of tube placement between the cephalic vein group,radial artery group and distal radial artery group(P > 0.05).Complications in the head vein group,radial artery group and distal radial artery group were not statistically significant(P > 0.05).After operation,the incidence of arm pain in the distal radial artery group was less than that in the cephalic vein group and the radial artery group,and the difference between the three groups was statistically significant(P < 0.05).Complications of internal fistula occlusion,arm swelling and local hematoma in the distal radial artery group were less than those in the cephalic vein group and radial artery group,and there was no difference between the three groups(P > 0.05).Comparison of blood flow between the three groups was statistically significant(P < 0.05).Conclusion:Interventional treatment of arteriovenous fistula stenosis via distal radial artery pathway has a high probability of success and a low probability of complications,blood flow can be restored immediately after surgery,it is a safe and feasible interventional method to treat the stenosis of arteriovenous fistula as well as the path of trans cephalic vein and radial artery.