Factors affecting the primary patency of native arteriovenous fistulas after ultrasound-guided percutaneous transluminal angioplasty

Abstract

Objective

By analyzing the clinical history, laboratory test indexes, and intraoperative ultrasound imaging data of patients receiving ultrasound-guided percutaneous transluminal angioplasty (UG-PTA) for the first time, the application value of UG-PTA in the treatment of peripheral stenosis of autogenous arteriovenous fistula (AVF) and the related factors affecting postoperative patency were investigated.

Methods

A total of 381 patients with dysfunction of radio-cephalic AVF were treated with UG-PTA from June 2017 to September 2019. According to the inclusion and exclusion criteria, 199 patients were included in this study. Baseline characteristics of patients, including demographic, clinical, and laboratory data, were collected. Kaplan–Meier’s survival curve was used to demonstrate the cumulative primary patency rate of UG-PTA. Univariate and multivariate Cox regression analysis was performed on clinical, anatomic, biochemical, and medication variables to identify the predictors of postintervention primary patency.

Results

The early technical success rate of UG-PTA was 98.4% (375/381). One hundred and ninety-nine patients, with an average age of 52.9 years, were analyzed, 97 of whom were males (48.7%). The median follow-up duration was 21 months. No major complication was observed. Postintervention primary patency rates were 87.7%, 75.8%, and 60.0% at 6, 12, and 24 months, respectively. A previously failed AVF (HR, 1.935, 95% CI 1.071–3.494; p = .029) and an increased level of parathyroid hormone (HR per 100 pg/mL increase, 1.105; 95% CI 1.014–1.203; p = .004) were identified as independent negative predictors of primary patency of UG-PTA.

Conclusions

UG-PTA is a safe and effective method for the treatment of peripheral stenosis of AVF. Previously failed AVF and elevated parathyroid hormone levels are associated with lower primary patency rate.

Keywords:

• Arteriovenous fistula
• ultrasound
• percutaneous transluminal angioplasty
• peripheral stenosis
• primary patency

Acknowledgements

The authors thank all of our colleagues working in the Department of Nephrology, Tongji Hospital.

Consent form

Written informed consent has been obtained from the patients to publish this paper.

Author contributions

FH and GX designed and supervised the study. XX, QL, YY, and YW collected data from patients. FH performed the operations. XX, XZ, and CZ analyzed the data and wrote the manuscript.

Disclosure statement

The authors report there are no competing interests to declare.

Data availability statement

The data underlying this article will be shared on reasonable request with the corresponding authors.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China under Grant Nos. [81974089 and 82230021] and the Frontier Application Basic Project of the Wuhan Science and Technology Bureau under Grant No. [2020020601012235].