| Objective:To investigate the clinical efficacy of stepwise balloon dilatation in the treatment of recurrent stenosis of autologous arteriovenous fistula.Methods:This bidirectional cohort study included 70 patients with forearm autogenous arteriovenous fistula stenosis admitted to a single center from February 2020 to February2022.Among them,36 patients(mean age 68.06 ± 11.55)received stepwise diameter balloon dilatation and 34 patients(mean age 63.47 ± 11.14)received universal diameter balloon dilatation.The primary endpoints were primary patency rate and secondary patency rate of target lesions.The secondary endpoints were technical success rate,clinical success rate,risk factors affecting the patency of target lesions and major complications.The primary safety endpoint was the incidence of adverse events within30 days.The patency rate of internal fistula in the two groups was described by Kaplan-Meier,and the difference analysis was tested by Log-rank.Cox proportional hazard model was used to analyze the risk factors of restenosis after PTA.The indexes with statistical differences in Cox univariate analysis and the indexes with clinical significance were included in multivariate survival analysis.The predictive value of balloon diameter and dilatation pressure on postoperative internal fistula restenosis was compared between the two groups.P < 0.05 was considered statistically significant.Results:In this study,the stepwise diameter balloon dilatation method was used as the experimental group,and the general diameter balloon dilatation method was used as the control group.The data showed that there was no statistical difference in baseline values between the two groups.The technical success rate and clinical success rate were 100 %.The study showed that the median survival time of the experimental group was longer than that of the control group in the first,second and third intervention results of the two surgical methods for stenosis fistula.There was no statistical difference in brachial artery blood flow and stenosis diameter before and after operation and within 1 year of follow-up.However,by log-rank test,there was no difference in survival rate between the two groups in the first and second intervention(P = 0.847,P = 0.145).In the third intervention,there was a difference in survival rate between the two groups(P = 0.001).There was no significant difference in complications between the two groups,and no adverse events occurred within 30 days.Univariate Cox analysis showed that hemoglobin,predialysis diastolic blood pressure and C-reactive protein were risk factors for restenosis,but multivariate analysis showed that they were not risk factors for restenosis.Through model calculation,balloon diameter was a risk factor for restenosis in the second intervention(RR = 0.613,95 % CI(0.378,0.994)),while dilatation pressure was not statistically significant for restenosis.In the third intervention,the age of the patient was a risk factor for restenosis(RR = 0.918,95 % CI(0.868,0.972)),and the risk of restenosis in patients with women gender was 2.881 times that of male,which was a risk factor(RR = 2.881,95 % CI(1.033,7.646)).The balloon diameter and expansion pressure were not statistically significant for restenosis.Conclusion:Compared with the general balloon dilatation method,the stepwise balloon dilatation method is superior in reducing the restenosis of the internal fistula and reducing the number of interventions.In the long run,the stepwise balloon dilatation group has a longer median survival time and a higher long-term patency rate.predialysis diastolic blood pressure and C-reactive protein were risk factors for restenosis.balloon diameter was a risk factor for restenosis in the second intervention,while dilation pressure was not statistically significant for restenosis.Hemoglobin,.Age is a risk factor for restenosis,and patients with women gender have a higher risk of restenosis than male. |
PDF Full Text Request