Predictors associated with early and late restenosis of arteriovenous fistulas and grafts after percutaneous transluminal angiography

Abstract

Background: The objective of this study was to assess postintervention patency and analyze the predictive factors associated with early and late restenosis after intervention in hemodialysis arteriovenous fistulas (AVF) and arteriovenous grafts (AVG).Methods: This study retrospectively analyzed 284 hemodialysis patients who underwent percutaneous transluminal angioplasty (PTA) due to AVF and AVG stenosis. A total of 350 PTA procedures were performed. Clinical, anatomical, biochemical, and technical variables were analyzed. Using univariate and multivariate analyses, we assessed the postintervention patency of PTA by follow-up, and identified the predictive factors taking into account competing risks.Results: Postintervention patency rates at 3, 6, 12, and 24 months were 86.5%, 66.4%, 42.6%, and 29.8%, respectively, with a median patency duration of 11±0.71 months. Kaplan-Meier analysis showed that the patency rate of the AVF group (n=271) was dramatically higher than the AVG group (n=79) at 3, 6, and 12 months after PTA, respectively (88.9% vs. 78.5%, 69.0% vs. 57.4%, 48.8% vs. 20.0%, P<0.01). Cox survival analysis revealed that the factors associated with postintervention patency of AVF included age of fistulas, serum albumin (ALB) levels, location of stenoses, lesion length longer than 2 cm, multiple stenoses, and maximal pressure of dilatation lower than 16 atm. In addition, factors related to postintervention patency of AVG included the presence of diabetes and hypertension, and serum ALB.Conclusions: This study demonstrated that the risk factors associated with postintervention patency of AVF included age of fistulas, lower levels of serum ALB, location of stenoses, lesion length longer than 2 cm, multiple stenoses, and maximal pressure of dilatation lower than 16 atm. In addition, risk factors related to postintervention patency of AVG included the presence of diabetes and lower levels of serum ALB, while the presence of hypertension was found to be a protective factor for reducing patency loss of AVG. Among all these factors, serum ALB and multiple stenoses tended to predict early restenosis, while pressure of dilatation tended to predict late restenosis.

In Reply to ‘Paclitaxel-Coated Balloon Angioplasty for Dysfunctional Arteriovenous Fistula’

“…Although there have been several trials focused on DCB angioplasty in the treatment of arteriovenous fistula (AVF) stenosis, there has been controversy surrounding its efficacy and safety. The higher proportion of de novo AVF lesions noted in our trial were in line with what is currently observed in China, 2 and as such, we agree that this may have a positive impact on postangioplasty patency compared with recurrent lesions. In addition, many other factors besides the use of DCBs, such as characteristics of the study population and of the AVF-for example, AVF location, AVF age, and presence of calcification, diabetes, and intimal hyperplasia [3][4][5][6][7] -may also impact postangioplasty AVF patency and requires further study.…”

Factors affecting arteriovenous access patency after percutaneous transluminal angioplasty in chronic haemodialysis patients under vascular access monitoring and surveillance: a single-centre observational study

“…Several previous studies report factors associated with postintervention AVF patency, including patient age, AVF age, presence of diabetes, length of stenosis and the presence of residual stenosis 9 12. AVG patency is negatively associated with diabetes and low levels of serum albumin 13. Hypertension is positively associated with patency in patients with AVF14 and AVG13.…”

“…AVG patency is negatively associated with diabetes and low levels of serum albumin 13. Hypertension is positively associated with patency in patients with AVF14 and AVG13. In addition, patients with AVG access have a greater risk of patency loss than do those with AVF 15.…”

“…Whether diabetes and hypertension influence postintervention patency remains controversial. Several studies suggest that diabetes and hypertension are not associated with patency after PTA,7 16 27 while others report that diabetes is an important risk factor for fistula restenosis12 28; another reports that diabetes is associated with lower AVG patency but has no relationship with AVF patency 13. We speculate that our finding that DPP-4 inhibitors and thiazolidinedione are negatively associated with post-PTA patency could be due in part to patient comorbidities and clinical conditions (eg, poorly controlled hyperglycaemic) rather than a direct effect on vascular patency.…”

Risk factors for blood vessel rupture during vascular access intervention therapy for hemodialysis patients

“…The average inflation pressure was 18 atm, and inflation pressures higher than the average did not significantly correlate with rupture risk in our study. Although the procedure for calibrating inflation pressures and the optimal inflation pressures are still under debate, inflating the balloon without high maximum pressure is one of the risk factors associated with the patency rate of AVF [20]. Other studies demonstrated no significant differences in rupture rates between low inflation pressures (10-14 atm) and high inflation pressures (24-30 atm) when dilating central venous stenosis in hemodialysis patients.…”