Factors affecting patency of arteriovenous fistula following first percutaneous transluminal angioplasty
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ORIGINAL ARTICLE
Factors affecting patency of arteriovenous fistula following first percutaneous transluminal angioplasty Yit‑Sheung Yap1 · Wen‑Che Chi1 · Cheng‑Hao Lin1 · Yi‑Chun Liu1 · Yi‑Wen Wu2 · Hui‑Yueh Yang3 Received: 8 December 2019 / Accepted: 13 August 2020 © Japanese Society of Nephrology 2020
Abstract Background Percutaneous transluminal angioplasty (PTA) has generally replaced surgical procedures to treat arteriovenous fistula (AVF) dysfunction, but the predictors of post-intervention patency are highly variable. This study aimed to determine predictors of primary patency following PTA of dysfunctional AVF. Materials and methods Retrospective analysis of first-time PTA of 307 AVF in 307 patients (171 males, mean age 64.3 ± 12.4 years). Demographic, clinical, anatomical and medication variables were reviewed and subjected to univariate and multivariate Cox regression analysis. Results The post-intervention primary patency rates at 6, 12, 24, and 36 months were 76.3%, 58.3%, 43.2%, and 38.2%, respectively. The higher aortic arch calcification (AAC) grade patients were older, had higher incidence of comorbidities and cardiomegaly, and younger AVF age, but their dialysis vintage term was shorter and diastolic blood pressure was lower, and the maximum diameter of balloon angioplasty was mostly ≤ 6 mm, and had lower phosphorus level and less calciumcontaining phosphate binder use. In multivariate Cox proportional hazard analysis, the presence of higher AAC grade [hazard ratio (95% confidence interval): (1.46 (1.02–2.09); p = 0.037)] and stenosis at upper arm [1.76 (1.16–2.67); p = 0.008] were associated with shorter post-intervention primary patency. Conclusion In conclusion, higher AAC grade and anatomic factor related to the location of AVF (upper arm) were the important predictors of AVF dysfunction after PTA. These results could assist in tailoring surveillance programs and performing appropriate interventions for risky AVF. Keywords Percutaneous transluminal angioplasty · Arteriovenous fistula · Aortic arch calcification · Hemodialysis patients
Introduction Vascular access failure is a leading cause of morbidity and mortality among hemodialysis populations, accounting for a high percentage of their hospitalizations [1], and for this reason, maintaining vascular access patency is an important aspect of patient care in these patients. Recently, percutaneous transluminal angioplasty (PTA) has generally replaced * Yit‑Sheung Yap [email protected] 1
Division of Nephrology, Department of Internal Medicine, Yuan’s General Hospital, No. 162, Chenggong 1st Road, LingYa District, Kaohsiung City 802, Taiwan, ROC
2
Chronic Kidney Disease Education Center, Yuan’s General Hospital, Kaohsiung 802, Taiwan
3
Hemodialysis Center, Yuan’s General Hospital, Kaohsiung 802, Taiwan
surgical procedures to treat access thrombosis owing to its convenience when performing the procedure and being less invasive [2]. Nonetheless, its benefit is attenuated by a high recurrent stenosis rate within 6 months [1].
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