Long-term Follow-up Results Of Arteriovenous Graft And Efficacy Of Percutaneous Transluminal Angioplasty In The Repair Of Internal Stenosis Or Occlusion

BackgroundChronic kidney disease(CKD)refers to kidney structure abnormal or dysfunction caused by various reasons for more than 3 months.An epidemiological survey in China in 2012 showed that the morbidity of CKD of adults in domestic reached 10.8%and there are approximately 120 million CKD patients in China over the age of 18.When their renal function progresses to ESRD stage,renal replacement therapy are required.Most ESRD patients in our country receive hemodialysis treatment.It is important to establish an effective hemodialysis access with long-term patency for ESRD patients.The most ideal hemodialysis access is autologous arteriovenous fistula(AVF),which has the advantages of simple surgery,high patency,and few complications.However,for patients with thin superficial or veins deep from the skin,mature disorders after AVF,insufficient puncture sites after long-term use of AVF,and AVF complications that cannot be repaired,the arteriovenous graft(AVG)is the first choice after AVF access.The proportion of AVG in the hemodialysis access of dialysis patients in China is low,for the understanding of postoperative complications and patency rate in AVG are not deep enough in clinical.It has been reported that the primary patency rates of AVG in 1 and 3 years are 40%to 75%and 14%to 44%abroad.Although the primary patency rate of AVG is worse than that of AVF,the secondary patency rate can reach a high rate after repairment.In the past,traditional open surgery was mostly used to treat stenosis or occlusion of AVG,such as bypass and patch formation.However,there are a series of problems in open surgery repair,such as operation trauma,which limit AVG repeated repair,risk of grafts infection etc.With the rapid development of intravascular technique,percutaneous transluminal angioplasty(PTA)is gradually popularized in the repair of stenosis and occlusion in AVG.Objectives1.To Observe the long-term patency rate,postoperative complications and other long-term results of AVG for maintenance hemodialysis.2.To evaluate long-term patency rate,postoperative complications of PTA for the treatment of hemodialy sis AVG internal stenosis and occlusion.MethodsThe clinical data of 131 patients who implanted AVG and 66 patients undergoing PTAs for AVG stenosis or occlusion were collected.Retrospective analysis and follow-up were performed.The Kaplan-Meier analysis was used to calculate the primary patency rate and secondary patency rate of AVG,and post-intervention primary patency rate and post-intervention cumulative patency rate after PTA.The Log-rank test was used for comparison between groups.When P<0.05,the difference was statistically significant.ResultsThe median follow-up time after AVG implanted in 131 patients was 22.8 months(from 2 months to 61 months).The average primary patency time of AVG was(22.2±1.97)months,and the primary patency rates at 1 year,2 years,and 3 years were 61.5%,36.6%and 23.2%,respectively.The average secondary patency time after AVG was(3 8.3±2.30)months,and the secondary patency rates after 1 year,2 years,and 3 years were 85.6%,68.6%,and 55.8%,,respectively.In this group of patients,65(49.6%)patients had thrombosis after operations,50(38.2%)had access stenosis,13(9.9%)had graft infections,and 2(1.5%)had pseudoaneurysm,2(1.5%)had hemodialysis access-induced distal ischemia,2(1.5%)had seroma.105 cases of patients with AVG stenosis or occlusion were able to reach the technical success standard after PTA and successfully dialyzed in 101 cases,with a technical success rate of 96.2%.The average post-intervention primary patency time of AVG was(12.1±1.20)months,(16.3±1.95)months in stenosis group and(10.3±1.36)months in occlusion group(χ2=4.335,P=0.037).The post-intervention primary patency rate for AVG after PTA in 6 months was 62.7%,78.1%in stenosis group,53.5%in occlusion group,respectively.The post-intervention primary patency rate in 1 year was 38.8%,48.9 in the stenosis group,33.1%in occlusion group.The average post-intervention cumulative patency time of AVG after PTA was(19.7±1.46)months.The post-intervention cumulative patency rate was 80.9%in 6 months,74.1%in 1 year.No statistically significant difference in post-intervention cumulative patency rate was observed between two groups.(χ2=0.392,P=0.531).No perioperative death occurred.ConclusionsA satisfactory secondary patency rate can be achieved in AVG through repair treatments.Regular follow-up,early detection of stenotic lesions and corresponding treatments are vital for long-term patency of AVG.The treatment of PTA for AVG internal stenosis and occlusion showed to be safe,effective,lesser trauma,with good experience of patients and a high post-intervention cumulative patency rate.Stenotic lesions have a higher incidence of restenosis after PTA treatment,so regular follow-up monitoring is required.