Influence Of Balloon Dilatation Pressure Of Percutaneous Transluminal Angioplasty On The Patency Rate Of Arteriovenous Fistula After PTA

Objective: To explore the effect of the maximum inflation pressure of percutaneous transluminal angioplasty(PTA)balloon on the patency rate of arteriovenous fistula stenosis within 12 months after PTA,and screen out the independent risk factors that affect restenosis after PTA.Methods: Enrolled 100 patients who successfully underwent PTA in the Department of Nephrology,the Third Hospital of Hebei Medical University from January 2019 to December 2019,and collected patients’ basic information,primary medical history,comorbidities,related serological indicators and types of fistula stenosis.Follow up the patients’ internal fistula patency for 12 months after PTA surgery through outpatient follow-up or telephone follow-up.According to the maximum pressure required to expand the stenosis during the operation,the patients are divided into high-pressure group(the maximum balloon pressure required to expand the stenosis≥20atm)and low-pressure group(the maximum balloon pressure required to expand the stenosis<20atm),compare the basic information,primary medical history,comorbidities,related serological indicators and postoperative patency rate of the two groups of patients,and analyze the risk factors of fistula restenosis after PTA.The ROC curve was used to evaluate the predictive value of the maximum balloon inflation pressure for restenosis within 12 months after PTA.Results: A total of 100 patients were enrolled in the study,48 males and52 females.The average age was(53.21±15.75)years old.The median dialysis age at PTA was 24.0(12.0,49.5)months,and the median life span of fistula was 12.6(5.1,37.4)months.All patients had completed follow-up.Compared with the low-pressure group,the high-pressure group had higher rates of diabetic kidney disease,hypertension,and restenosis within 12 months after PTA,and the difference was statistically significant(P<0.05).The patency rate of the low-pressure group was higher than that of the high-pressure group at 12 months after PTA(Log rank test,X~2=5.399,P=0.020).COX multivariate survival analysis showed that the maximum expansion pressure required to expand the stenosis and hypomagnesemia were independent risk factors for restenosis after PTA(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of the maximum balloon inflation pressure during PTA was 0.619(95%CI 0.496-0.742,P<0.05),which has diagnostic value.The optimal maximum pressure prediction threshold is 19 atm,the sensitivity is 60.5%,and the specificity is 66.1%.Conclusions: Patients with primary disease of diabetic kidney disease or complicated with hypertension often require higher balloon dilation pressure during PTA.Patients who require higher expansion pressure during PTA are more likely to have restenosis;the mechanism may be related to the higher degree of mechanical damage to the vascular intima and media due to the high balloon expansion pressure.In clinical work,the maximum pressure required to expand the stenosis can be used to predict restenosis within 12 months after surgery.For the patients with a maximum pressure higher than 19 atm,more postoperative monitoring and closer follow-up should be given.