Analysis of the risk factors for recurrence of juxta-anastomotic stenosis in wrist arteriovenous fistula af-ter percutaneous transluminal angioplasty:a single-center prospective cohort study
Objective This study aimed to explore the risk factors for restenosis of the juxta-anastomotic stenosis in radial-cephalic arteriovenous fistula(RC-AVF)after primary percutaneous transluminal angioplas-ty(PTA).Methods A single-center prospective study was conducted,to analyze the patients with arteriove-nous fistula(AVF)undergoing PTA treatment between January,2021 and June 2022.Their demographics,le-sional characteristics,technical factors,and auxiliary examination results were collected.Risk factors for reste-nosis after PTA were evaluated using univariate and multivariable analyses.Results A total of 114 patients with RC-AVF successfully completed the first PTA treatment with a technical success rate of 95.0％(114/120),and 112 patients finished follow-up the primary assistant patency time was 512.15±226.32 days,and the secondary patency time was 554.88±205.67 days.After PTA for 90,180,360,and 540 days,the primary paten-cy rates were 94.6％,81.3％,56.1％,and 33.3％,respectively;the primary assistant patency rates were 97.3％,95.5％,85.1％,and 70.1％,respectively;the secondary patency rates were 100％,100％,95.7％,and 85.7％,re-spectively.Cox regression analysis showed that balloon diameter(HR=0.62,95％CI:0.43～0.89,P=0.009)was the independent predicting factor for primary patency loss after PTA.ROC curve analysis showed an AUC area of 0.614(95％CI:0.510～0.718,P=0.037)and a critical value of 6.0 mm.Stenosis length(HR=1.04,95％CI:1.02～1.07,P＜0.001)and stenosis number(HR=3.73,95％CI:1.32～10.54,P=0.013)were the independent predicting factors for primary assistant patency loss after PTA,with AUC areas of 0.686(95％CI:0.543～0.838,P=0.009)and 0.685(95％CI:0.559～0.810,P=0.010),critical values of 17.5 mm and 2.Conclusions Restenosis of the juxta-anastomotic venous stenosis in RC-AVF after primary PTA re-mains high.Balloon diameter is closely related to the restenosis after PTA.The use of a balloon with a maxi-mum diameter＜6 mm is an independent predictor for primary patency loss after PTA.Longer stenosis(≥ 17.5 mm)and stenosis number ≥ 2 are the independent predictors for primary assistant patency loss after PTA.
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