The Influence Of PTA On The Pulmonary Arterial Pressure Of Hemodialysis Patients With Occluded Arterio-venous Fistula

Objective:To investigate the effect of percutaneous transluminal angioplasty(PTA)on pulmonary arterial pressure in maintenance hemodialysis(MHD)patients with occluded arterio-venous fistula(AVF).Method:In this clinical prospective observational study,total 55 MHD patients with AVF occlusion were recruited in Hunan Provincial People’s Hospital from September 2019 to March 2021.Of them,40 patients voluntarily underwent PTA,37 cases were successful and 3 cases failed.Among the remaining 15 patients,5 were excluded due to loss of follow-up or kidney transplantation.Three patients with PTA failure and the remaining 10 patients(a total of 13)were converted to tunneled central venous catheterization(CVC).The changes of pulmonary arterial pressure(PAP),left ventricular ejection fraction(LVEF),cardiac output(CO)and brachial blood flow in successful PTA patients were recorded by Doppler echocardiography before and 24 hours after surgery and 1 month after follow-up,and were compared respectively.Clinical data including gender,age,smoking history,hemodialysis time,hemoglobin level,C-reactive protein level,serum calcium level,serum phosphorus level,parathyroid hormone level,ET-1 level and NO level were collected from all 50 patients(except 5 excluded patients),and the correlation between them and PAP were analyzed.In addition,general data of all patients were collected.Result:1.In the patients underwent PTA,the levels of ET-1(P<0.001),CO(P<0.001),PAP(P=0.036)and brachial artery blood flow(P<0.001)in the 24 hours after PTA were significantly higher than those of pre-PTA,while the levels of NO(P<0.001)and LVEF(P=0.026)were significantly lower than those of pre-PTA.2.In the patients underwent PTA,there was no significant difference in the levels of ET-1,NO,CO,LVEF and PAP between pre-PTA and one month after PTA(P>0.05).But after one month,the level of brachial artery blood flow was significantly higher than that of pre-PTA(P<0.001).3.In the patients underwent PTA,there was no significant difference in the level of brachial artery blood flow between 24 hours after PTA and one month after PTA(P>0.05).But after one month,the levels of ET-1(P<0.001),CO(P<0.001)and PAP(P=0.006)were significantly lower than those of 24 hours after PTA,while the levels of NO(P<0.001)and LVEF(P=0.004)were significantly higher than those of 24 hours after PTA.4.Pearson correlation analysis showed that the PAP of smoking patients was significantly higher than that of non-smoking patients(P=0.034).PAP was positively correlated with hemodialysis time(r=0.658,P=0.031),C-reactive protein(r=0.732,P=0.018),ET-1(r=0.623,P=0.011),serum phosphorus(r=0.652,P=0.025)and parathyroid hormone(r=0.587,P=0.017),while negatively correlated with hemoglobin(r=-0.754,P=0.019)and NO(r=-0.725,P=0.022).Conclusion:1.The restoration of AVF blood flow after PTA in MHD patients with AVF occlusion will significantly affect PAP in a short time,but as time goes by,it has little effect on PAP.2.The PAP of hemodialysis patients was positively correlated with hemodialysis time,C-reactive protein,ET-1,serum phosphorus and parathyroid hormone levels,and negatively correlated with hemoglobin and NO levels.