| Objective:To investigate whether there is a correlation between the intimal thickness of the cephalic vein and the primary patency rate after the first balloon dilatation in patients with autologous arteriovenous fistula(AVF)stenosis.Methods:Retrospectively included 83 patients who were treated with percutaneous transluminal angioplasty(PTA)for the first time in the department of nephrology of Shanxi Bethune Hospital from October 2020 to October 2021 with AVF stenosis after maturity.The AVF operation was end to side anastomosis of cephalic vein and radial artery,and the stenosis was located near the anastomotic vein segment.Collect age,sex,serum albumin(ALB),low-density lipoprotein(LDL),serum creatinine(Scr),systolic blood pressure(SBP),diastolic blood pressure(DBP),body mass index(BMI),whether smoking,whether diabetes is combined,whether anticoagulant/antiplatelet drugs are used,average intimal thickness of stenosis before PTA,minimum vascular diameter of stenosis,brachial artery blood flow(BAF),vascular access age(VA),stenosis length indicators.According to the median of mean intimal thickness of stenosis,they were divided into high intimal thickness group(> 0.51mm)and low intimal thickness group(≤ 0.51mm).The differences of various indicators between the groups were compared.The follow-up period was 1 year.Kaplan Meier was used to calculate the overall and group primary patency rates at 3months,6 months,and 1 year after PTA.Log Rank was used to test the differences between groups,and Cox regression was used to analyze the influencing factors of primary patency rates after the first PTA.Results:83 patients with proximal anastomotic vein segment stenosis who received PTA treatment for the first time were included.After grouping according to the median pre PTA average intimal thickness,42 patients were included in the high intimal thickness group and 41 patients were included in the low intimal thickness group.Analysis of baseline indicators showed no statistically significant differences between the groups(P>0.05);The average intimal thickness at the stenosis site and the minimum vascular diameter at the stenosis site were compared,and the differences between the groups were statistically significant(P<0.05).After PTA,82 cases of internal fistula were successfully opened,with a clinical success rate of 98.8%.82 patients underwent follow-up analysis,including 41 cases in the high endometrial thickness group and 41 cases in the low endometrial thickness group.At3,6,and 12 months after the first PTA,the primary patency rates were 91.9%,76.1%,and54.9%,respectively.The primary patency rates of the high and low endometrial thickness groups were 84.8% vs 66.0%,96.8% vs 82.9%,respectively,at 3 and 6 months,with statistically significant differences(P<0.05);The primary patency rates of the two groups at 12 months were 45.5% vs 61.2%,with no statistically significant difference(P>0.05).Univariate and multivariate Cox regression analysis found that the average intimal thickness,stenosis length,and VA at the stenosis site had statistically significant effects on the primary patency rate after PTA(P<0.05).Among them,the average intimal thickness at the stenosis site has the greatest impact on the primary patency rate after PTA(HR=3.34,95% CI 1.30-8.58,P=0.012).Conclusion:Research has shown that the average intimal thickness,stenosis length,and VA at the stenosis site are independent risk factors affecting the primary patency rate after PTA.Among them,the average intimal thickness at the stenosis site has the greatest impact on the primary patency rate after PTA.In the early stage after PTA,there is a significant correlation between the average intimal thickness at the stenosis site and the primary patency rate,indicating the importance of high intimal thickness in early prediction of postoperative failure,and providing new clinical ideas for preventing stenosis recurrence. |
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