Types Of Arteriovenous Fistula Stenosis In MHD Patient And Analysis Of Different Surgical Methods For Treatment Of Type ? Combined With ? Stenosis

Part I: The Analysis of arteriovenous fistula stenosis type in MHD patientObjective: Investigate the relationship between stenosis type and clinical data such as gender,age and dialysis age with primary disease of upper limb arteriovenous fistula in hemodialysis patient.Methods: 250 arteriovenous fistula stenosis patients were admitted from 2013 to 2019 year.and were classified into four groups: simple type I stenosis,simple type II stenosis,type I combined with II stenosis and simple type III stenosis.Analysis the correlation between age,sex,primary disease,dialysis age,arteriovenous fistula type with arteriovenous fistula stenosis type,P<0.05 shows that there is statistical difference.Results:There were 100 patients(40%)in type I combined with II stenosis group,97 patients(38.8%)in type I stenosis group,48 patients(19.2%)in type II stenosis group,and 5 patients(2%)in type III stenosis group.There were no statistical difference in sex,age and primary disease among the four groups(P>0.05).The dialysis age in type I stenosis group was 12(43)months,in type II stenosis group was 24(36)months,in type I combined with II stenosis group was 30(51)months,and in type III stenosis group was 72(90)months.There were statistical differences in dialysis age among the four groups(P<0.05),and there was statistical difference between type I and type I combined with II(p < 0.05).In 240 patients with radiocephalic fistula,there were 93 patients in type I stenosis group(38.8%),48 patients in type II stenosis group(20%),97 patients in type I combined with II stenosis group(40.4%),and 2 patients in type III stenosis group(0.8%);In seven patients with ulnar-basilic fistula,there were 4 patients in type I stenosis group(57%),3 patients in type I combined with II stenosis group(43%).In three patients of brachiocephalic fistula,there were all in type III stenosis.group There were statistical differences among the four groups in different types of fistula type(P<0.05),and there was statistical difference between type I stenosis group and type III stenosis group,between type II stenosis group and type III stenosis group,between type I combined with II stenosis group and type III stenosis group,Respectively(P<0.05).Conclusions: Type I combined with type II stenosis is the most common stenosis type,followed by type I stenosis;The longer the dialysis age,the easier to form type I combined with II stenosis.Simple type I stenosis has the shortest dialysis age,which requires early detection and intervention so as to prolong the life of vascular access.Radiaocephalic fistula and ulnar-basilic fistula are easy to form type I stenosis and type I combined with II stenosis,while brachiocephalic fistula is easy to form type III stenosis.Part II: Analysis the Effect of Different Surgical Methods in Treating Type I Combined with II StenosisObjective: To investigate the surgical effect,long-term patency rate and economic benefits of different surgical methods in upper limb arteriovenous fistula type I complicated with II stenosis,so as to provide basis for selecting appropriate surgical method for patient with such stenosis.Methods: 40 patients with arteriovenous fistula type I complicated with II stenosis were admitted from 2018 to 2019 year,of which 14 cases in group A were percutaneous transluminal angioplasty(PTA)combined with open surgery,18 cases in group B were ultrasound guided PTA,and 8 cases in group C were digital subtraction angiography(DSA)guided PTA.The three groups were compared and analyzed in terms of success rate of operation,changes of vessel diameter and blood flow,long-term patency rate and expenses.Results:There was no statistical difference in preoperative baseline data(gender,age,primary disease etc.)among the three groups(P>0.05).The success rate of operation was 100% in group A,72% in group B,and 50% in group C,There were statistical difference among the three groups in success rate of operation(P<0.05),and there was statistical difference between group A and group B,between group A and group C,Respectively(P<0.05).The postoperative diameter of blood vessel in the three groups was significantly higher than that in preoperative diameter(P<0.05).the postoperative diameter in group A was larger than that in the other two groups,and there was statistical difference between group A and group B,between group A and group C,Respectively(P<0.05).The postoperative compliance rate of brachial artery blood flow was 100% in the three groups,which was significantly higher than in preoperative blood flow(P<0.05).the postoperative brachial artery blood flow in group A was higher than that in the other two groups,and there was statistical difference between group A and group B(P<0.05).The expense of group A were $7804.57±424.17,group B were $6834.15±681.58,group C were $8231.00±1845.68.The expense of the three groups were statistically different(P<0.05),and there was statistical difference between group A and group B,between group B and group C,respectively(P<0.05).The cumulative survival rate in three,six and twelve months were 78.6%,69.8% and 55.9% respectively in group A;76.9%,51.9%,51.9% in group B;75%,37.5%,37.5% in group C.The survival curve of group A was smoother than group B and group C,with a longer survival period.There was no statistical difference among the three groups(P>0.05).Conclusions: PTA combined with open surgery has advantage in the success rate of operation,long-term patency rate,improvement of postoperative diameter of blood vessels and brachial artery blood flow in treatmenting type I combined with II stenosis,but it is worse than ultrasound guided PTA and DSA guided PTA in saving vascular resource,and the expense is higher than ultrasound guided PTA.The current results show that PTA combined with open surgery has application value in treating patient with type I combined with II stenosis.