To Evaluate The Efficacy Of Ultrasound-guided Intravascular Thrombolysis Combined With Percutaneous Transluminal Angioplasty In The Treatment Of Thrombosis In Autogenous Arteriovenous Fistula

Objective:1.To explore the predictive factors for the diagnosis of thrombosis of autologous arteriovenous fistula(AVF),and to construct a combined predictive factor for the diagnosis of AVF thrombosis,and to analyze the predictive value of predictive factors and combined predictivefactors for thediagnosis of AVF thrombosis.2.To investigate the efficacy of ultrasound-guided intravascular thrombolysis combined with Percutaneoius Transluminal Angioplasty(PTA)in the treatment of thrombosis in autogenous arteriovenous fistula.Methods:1.A retrospective analysis was performed on patients with thrombosis of autogenous arteriovenous fistula diagnosed by color Doppler ultrasound for the first time in the Department of Nephrology of the First Affiliated Hospital of Gannan Medical College from September2019 to September 2021(thrombosis group).At the same time,patients with good AVF function were selected as the control group(patency group).The baseline data and biochemical data of the patients were collected.By comparing the baseline data of the thrombosis group and the patency group,the predictive factors for the diagnosis of AVF thrombosis were analyzed by statistical methods,and the combined predictive factors for the diagnosis of AVF thrombosis were further constructed to evaluate the predictive value of the predictive factors and the combinedpredictive factors in thediagnosis of AVFthrombosis.2.From September 2019 to September 2021,patients who were diagnosed with autologous arteriovenous fistula thrombosis by color Doppler ultrasound for the first time and accepted ultrasound-guided thrombolysis combined with PTA in the Department of Nephrology,the First Affiliated Hospital of Gannan Medical College were retrospectively analyzed.The baseline data,surgical data,follow-up data of postoperative patency rate of patients with AVF thrombosis were collected.The efficacy of ultrasound-guided intracavitary thrombolysis combined with PTA in the treatment of AVF thrombosis was analyzed by statisticalmethods,andthe occurrence of adverse events was recorded.Results:1.Atotal of 162 patients with AVF thrombosis and 267 patients with good fistula function were enrolled in this study.Platelet(PLT),Platelet Large Cell Ratio(P-LCR),Mean Platelet Volume(MPV),Platelet distribution width(Platelet)Distribution Width,PDW),Homocysteine(HCY),Monocyte(MNC),Calcium(Ca),Phosphorus(P),and Parathyroid Hormone,PTH)in Logistic regression analysis,P <0.05,the difference was statistically significant.The combined prediction factor A for the diagnosis of autogenous arteriovenous fistula thrombosis was established based on the above nine predictors,the combined predictor A=1.990*Ca+1.720*P+0.100*PTH+2.140*MNC+0.032*PLT+1.819*MPV+0.966*PDW+0.384*P-LCR+0.128*HCY.was further constructed as a combined predictor for the diagnosis of thrombosis in autogenous arteriovenous fistula.The area under the ROC curve of combined predictor A was 0.999,indicating that the predictive value of combined predictor A for the diagnosis of AVF thrombosis was very good.When the cut-off value of combined predictor A was 94.5339,the sensitivity was 98.8%,and the specificity was 98.5%,thepredictivevalue was very good,and the predictive accuracy was 98.6%.The combined predictor B=1.990*Ca+1.720*P+0.100*PTH was constructed based on the three indicators of calcium,phosphorus and parathyroid hormone.The area under the ROC curve of combined predictor B was 0.962,indicating that the combined predictor B had a good predictive value for the diagnosis of AVF thrombosis.When the cut-off valueof the combined predictor B was 14.3367,the sensitivity was 94.4%,and the specificity was 90.3%.The predictive value of the combined predictor was good,and the predictive accuracy rate was 91.8%.The combined predictor C=1.819*MPV+0.966*PDW was constructed based on the two indicators of MPV and PDW,and the area under the ROC curve of the combined predictor C was 0.943,indicating that the combined predictor C had a better predictive value for the diagnosis of AVF thrombosis.When the cut-off value was 18.9037,the combined predictor C had a better predictive value for the diagnosis of AVF thrombosis.The sensitivity was 84.0%,and the specificity was 91.4%.The predictive value was good,and the predictive accuracy was 88.6%.Diabetes mellitus in the thrombosis group and patency group in single factor comparison,P<0.05,the difference was statistically significant,further logistic regression analysis,P<0.05,the difference was statistically significant.2.There was significant difference between preoperative and postoperative vascular diameter(P=0.00,<0.05).The brachial artery blood flow before and after operation were compared,P=0.00(<0.05),the difference was statistically significant.Compared with preoperative dialysis blood flow and postoperative dialysis blood flow,P=0.001(<0.05),the difference was statistically significant.The primary patency rate was 96.5% at 3 months,91.3%at 6 months,87.3% at 9 months and 85.7% at 12 months.The secondary patency rate was98.95% at 3 months,97.9% at 6 months,95.85% at 9 months and 93.4% at 12 months.There were no complications such as systemic hemorrhage,pulmonary embolism,vascular rupture andso on in all patients treatedwith PTAby ultrasound-guided intravascular thrombolysis.Conclusion:1.Platelet,large platelet volume,mean platelet volume,platelet distribution width,homocysteine,monocytes,calcium,phosphorus and parathyroid hormone are predictive factors for the diagnosis of thrombosis in autogenous arteriovenous fistula,which have predictive value for the diagnosis of thrombosis in autogenous arteriovenous fistula.The combined predictor A constructed by combining the above nine predictors has a very good predictive value for the diagnosis of thrombosis in autogenous arteriovenous fistula.The combined predictor B constructed by calcium,phosphorus and parathyroid hormone has a better predictive value in the diagnosis of thrombosis in autogenous arteriovenous fistula.The combined predictor C constructed by MPV and PDW has a good predictive value in the diagnosis of thrombosis in autogenous arteriovenous fistula.The above indicators are cheap and easy to obtain,and have good predictive value for the diagnosis of thrombosis in autogenous arteriovenous fistula,which is worthy of clinical application.Diabetes is a predictive factor for the diagnosis of AVF thrombosis.2.Intravascular thrombolysis combined with percutaneous transluminal angioplasty under ultrasound guidance is safe and effective in the treatment of thrombosis in autogenous arteriovenous fistula.