Clinical Study Of Autologous Arteriovenous Fistula After Arterial Dilation By PTA Technique In Hemodialysis Patients

Objective:To investigate the effectiveness and maturity rate of ultrasound-guided percutaneous transluminal angioplasty(PTA)in dilating the artery(radial or ulnar artery)to establish autologous arteriovenous fistula in hemodialysis patients.Methods:The clinical data of 60 patients who needed hemodialysis in the affiliated Cancer Hospital of Guizhou Medical University from June 2020 to April 2021 were collected.The patients were divided into two groups according to the inte rnal diameter of artery(radial artery or ulnar artery).In the study group,30 patients were divided into two groups: vein diameter≥ 2.0mm,artery diameter < 1.5mm.In the control group,there were 30 patients with venous diameter ≥ 2.0mm and arterial diameter ≥ 1.5mm.The clinical data of patients in the study group were collected,including primary disease,sex,age,preoperative peak arterial flow velocity,preoperative arterial diameter,preoperative venous diameter,subcutaneous distance,postoperati ve arterial peak flow velocity,postoperative arterial diameter,postoperative venous diameter.Follow-up monitoring of brachial artery blood flow,resistance index,vein diameter and internal fistula maturity of patients with autologous arteriovenous fist ula at 1 day,4 weeks,6 weeks and 8 weeks after operation.Collect the relevant clinical data of the control group,including primary disease,sex and age,follow-up and monitor the brachial artery blood flow,resistance index,vein diameter and internal fistula maturity on the 1st day,4th week,6th week and 8th week after the establishment of autologous art eriovenous fistula.Results:1.After ultrasound-guided PTA-assisted arterial dilatation in the study group,it was observed that the arterial diamete r and peak arterial flow velocity were significantly increased after operation(P < 0.0001).Among them,2 patients did not meet the standard of successful PTA dilatation,and the diameter was too small to meet the requirements for the establishment of arteriovenous fistula,so the success rate of ultrasound-assisted PTA-assisted arterial dilatation was 93.33 %(28/30).The success rate of establishing internal fistula was 93.33%(28 /30).2.There was no significant difference in brachial artery blood flow,resistance index and vein diameter between the study group and the control group on the 1st day,4th week,6th week and 8th week after operation.3.In the comparison between the study group and the control group,there was significant difference in the matur ity rate between the study group and the control group at the 4th week after operation,but there was no significant difference between the study group and the control group at the 6th and 8th week,indicating that at the 4th week after operation,the establishment of autologous arteriovenous fistula after arterial dilatation assisted by PTA may promote th e early maturation of autologous arteriovenous fistula.Conclusion:1.Ultrasound-guided PTA-assisted dilatation of artery can improve the success rate of establi shing autologous arteriovenous fistula in patients with artery diameter < 1.5mm.2.The effect of establishing autologous arteriovenous fistula after dilating artery(artery diameter < 1.5mm)under the guidance of ultrasound in hemodialysis patients is the same as that of establishing autologous arteriovenous fistula directly after arterial d iameter≥1.5mm,but the establishment of autologous arteriovenous fistula after PTA-assisted arterial dilatation may promote the early maturation of autologous arteriovenous fistula.