Li Chen1, Weichen Zhang2, Jinyun Tan3, Min Hu3, Weihao Shi4, Minmin Zhang5, Yong Wang1, Bo Yu3,4, Jing Chen5. 1. Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China. 2. Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China, zhangweichen1992@126.com. 3. Department of Vascular Surgery, Huashan Hospital, Fudan University, Shanghai, China. 4. Department of Vascular Surgery, Pudong Hospital, Fudan University, Shanghai, China. 5. Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China.
Abstract
BACKGROUND: Neointimal hyperplasia (NIH) is believed to be the main reason for arteriovenous fistula (AVF) dysfunction, but other mechanisms are also recognized to be involved in the pathophysiological process. This study investigated whether different morphological types of AVF lesions are associated with the patency rate after percutaneous transluminal angioplasty (PTA). METHODS: This retrospective study included 120 patients who underwent PTA for autogenous AVF dysfunction. All the cases were evaluated under Doppler ultrasound (DU) before intervention and divided into 3 types: Type I (NIH type), Type II (non-NIH type), and Type III (mixed type). Prognostic and clinical data were analyzed by Kaplan-Meier analysis and the Cox proportional hazards model. RESULTS: There was no statistical difference in baseline variables among groups, except for lumen diameter. The primary patency rates in Type I, Type II, and Type III groups were 78.4, 93.2, and 83.2% at 6 months and 59.5, 84.7, and 75.5% at 1 year, respectively. The secondary patency rates in Type I, Type II, and Type III groups were 94.4, 97.1, and 100% at 6 months and 90.5, 97.1, and 94.7% at 1 year, respectively. The Kaplan-Meier curve showed that the primary and secondary patency rates of Type I group were lower than those of Type II group. Multivariable Cox regression analysis demonstrated that postoperative primary patency was correlated with end-to-end anastomosis (hazard ratio [HR] = 2.997, p = 0.008, 95% confidence interval [CI]: 1.328-6.764) and Type I lesion (HR = 5.395, p = 0.004, 95% CI: 1.730-16.824). CONCLUSIONS: NIH-dominant lesions of AVF evaluated by DU preoperatively were a risk factor for poor primary and secondary patency rate after PTA in hemodialysis patients.
BACKGROUND: Neointimal hyperplasia (NIH) is believed to be the main reason for arteriovenous fistula (AVF) dysfunction, but other mechanisms are also recognized to be involved in the pathophysiological process. This study investigated whether different morphological types of AVF lesions are associated with the patency rate after percutaneous transluminal angioplasty (PTA). METHODS: This retrospective study included 120 patients who underwent PTA for autogenous AVF dysfunction. All the cases were evaluated under Doppler ultrasound (DU) before intervention and divided into 3 types: Type I (NIH type), Type II (non-NIH type), and Type III (mixed type). Prognostic and clinical data were analyzed by Kaplan-Meier analysis and the Cox proportional hazards model. RESULTS: There was no statistical difference in baseline variables among groups, except for lumen diameter. The primary patency rates in Type I, Type II, and Type III groups were 78.4, 93.2, and 83.2% at 6 months and 59.5, 84.7, and 75.5% at 1 year, respectively. The secondary patency rates in Type I, Type II, and Type III groups were 94.4, 97.1, and 100% at 6 months and 90.5, 97.1, and 94.7% at 1 year, respectively. The Kaplan-Meier curve showed that the primary and secondary patency rates of Type I group were lower than those of Type II group. Multivariable Cox regression analysis demonstrated that postoperative primary patency was correlated with end-to-end anastomosis (hazard ratio [HR] = 2.997, p = 0.008, 95% confidence interval [CI]: 1.328-6.764) and Type I lesion (HR = 5.395, p = 0.004, 95% CI: 1.730-16.824). CONCLUSIONS: NIH-dominant lesions of AVF evaluated by DU preoperatively were a risk factor for poor primary and secondary patency rate after PTA in hemodialysis patients.
Authors: Charmaine E Lok; Thomas S Huber; Timmy Lee; Surendra Shenoy; Alexander S Yevzlin; Kenneth Abreo; Michael Allon; Arif Asif; Brad C Astor; Marc H Glickman; Janet Graham; Louise M Moist; Dheeraj K Rajan; Cynthia Roberts; Tushar J Vachharajani; Rudolph P Valentini Journal: Am J Kidney Dis Date: 2020-03-12 Impact factor: 8.860
Authors: Marwan Tabbara; Juan C Duque; Laisel Martinez; Luis A Escobar; Wensong Wu; Yue Pan; Natasha Fernandez; Omaida C Velazquez; Edgar A Jaimes; Loay H Salman; Roberto I Vazquez-Padron Journal: Am J Kidney Dis Date: 2016-03-22 Impact factor: 8.860
Authors: Tonia C Rothuizen; Chunyu Wong; Paul H A Quax; Anton Jan van Zonneveld; Ton J Rabelink; Joris I Rotmans Journal: Nephrol Dial Transplant Date: 2013-03-29 Impact factor: 5.992
Authors: Michael Allon; Silvio Litovsky; Carlton J Young; Mark H Deierhoi; Jeremy Goodman; Michael Hanaway; Mark E Lockhart; Michelle L Robbin Journal: Am J Kidney Dis Date: 2011-06-30 Impact factor: 8.860