Objective The efficacy and prognosis of refractory stenosis in vascular access treated with a progressive treatment strategy were evaluated in order to find out suitable and effective approaches to main-tain patency of vascular access.Methods The patients with stenosis in autologous arteriovenous fistula(AVF)at a higher site in cephalic vein arch and those with stenosis in artificial arteriovenous graft(AVG)at the venous anastomosis area treated with ultrasound-guided percutaneous transluminal angioplasty(PTA)for the first time in the Blood Purification Center of The Second Affiliated Hospital of Nanjing Medical Universi-ty during the period from June 2020 to June 2021 were retrospectively analyzed.Progressive treatment strate-gy was used to maintain the patency of blood access for hemodialysis.Their patency and re-intervention rates were followed up for 24 months.The efficacy of progressive treatment strategy was compared to the progno-sis of the patients with similar stenosis lesions only treated with PTA in the same blood purification center.Results A total of 31 patients having stenosis in AVF at a higher site in cephalic vein arch used the progres-sive treatment strategy,and 16 patients having the similar stenosis used the high pressure balloon dilation alone.After 24 months of follow-up,there were statistical differences in re-intervention times(t=4.461,P＜0.001),average patency period after re-intervention(t=3.550,P＜0.001)and PTA assistant patency rate(x2=5.562,P=0.021)between the two groups.A total of 68 patients having stenosis in AVG at the venous anasto-mosis area used the progressive treatment strategy,and 58 patients having the similar stenosis used the high pressure balloon dilation alone.After 24 months of follow-up,there were statistical differences in re-interven-tion times(t=5.094,P＜0.001)and average patency period after re-intervention(t=3.251,P=0.002)between the two groups.Conclusion The progressive treatment strategy used suitable endovascular instruments and surgical approaches step-by-step to treat the refractory stenosis in AVF or AVG gradually.This method in-creased the patency rate,reduced the re-intervention times,and improved the prognosis of the patients.
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维普
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