Study On The Safety And Effectiveness Of Balloon Dilation Combined With Transcatheter Thrombolysis In The Treatment Of Autogenous Arteriovenous Fistula Stenosis And Thrombosis

Purpose:To explore the clinical effect of percutaneous transluminal angioplasty(PTA)in the treatment of acute autogenous arteriovenous fistula(AVF)stenosis with thrombosis,and provide more theoretical and practical basis for clinical research.Materials and methods:A retrospective study was conducted to collect 165 AVF patients with stenosis and thrombosis admitted to the affiliated hospital of Jinggangshan University from January 2019 to January 2021.According to different treatment methods,they were divided into treatment group(thrombolysis combined with PTA)and control group(catheter thrombolysis combined with PTA);The clinical baseline data and perioperative related indicators of the two groups were statistically analyzed,including operation success rate,primary patency rate,secondary primary patency rate and complication rate.Result:There was little difference between the two groups in the clinical baseline data(age,gender,AVF use time,average dialysis time,arteriovenous fistula type,disease type,and lesion characteristics).The left forearm arteriovenous fistula accounted for the main proportion in both groups,and hypertensive nephropathy,glomerulonephritis,and diabetes nephropathy were the main disease types.Stenosis of fistula and vein segment was the main type of stenosis in patients,and the difference was not statistically significant(P>0.05).There was no significant difference between the two groups in the amount of intraoperative bleeding,the number of balloons used,the time of tremor disappearance,the length of hospitalization,and the cost of hospitalization(P>0.05).The operation time of the control group was shorter than that of the observation group,and the success rate of the operation in the observation group was higher than that of the control group,the difference was statistically significant(P<0.05).In the control group,there were 5cases of hematoma,2 cases of blood leakage at the puncture point,1 case of blood vessel rupture,2 cases of steal syndrome,2 cases of nasal bleeding,3 cases of gingival bleeding,without asymptomatic pulmonary embolism and cardio-cerebrovascular accidents during the operation,resulting the overall complication rate 18.28%.In the observation group,2 cases of hematoma,1 case of bleeding at the puncture point,2 cases of vascular rupture,asymptomatic pulmonary embolism,cardio-cerebrovascular accident,steal syndrome,epistaxis and gingival bleeding occurred during the operation.The overall complication rate was 6.02%.The difference of complications between the two groups was statistically significant(P<0.05).The primary patency rate and auxiliary primary patency rate of patients in the two groups were significantly decreased at 3 months,6 M,9 M and 12 M after operation.The primary patency rate of patients in the observation group at 6 M,9 M and 12 M after operation was higher than that in the control group at 12 M after operation,with statistical significance(P<0.05).Conclusion:Compared with thrombolytic therapy,hyperbaric balloon dilation combined with transcatheter thrombolysis can significantly improve the success rate of surgery in patients with stenosis of autogenous arteriovenous fistula,improve the primary patency rate after surgery,assist the primary patency rate,reduce the incidence of complications,safe and effective,which is worthy of further clinical research.