Linchuang shenzangbing zazhi (Mar 2024)

Analysis of influencing factors for restenosis after percutaneous transluminal angioplasty in hemodialysis patients

  • Shen Zhan,
  • Bin Zhao,
  • Li-hong Zhang,
  • Yu-zhu Wang

DOI
https://doi.org/10.3969/j.issn.1671-2390.2024.03.004
Journal volume & issue
Vol. 24, no. 3
pp. 200 – 208

Abstract

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Objective To explore the influencing factors of restenosis after percutaneous transluminal angioplasty in hemodialysis （HD） patients and provide a basis for predicting the risk of dysfunction and prolonging the service time. Methods Retrospective analysis was performed on the clinical and follow-up data of 335 patients who underwent percutaneous transluminal angioplasty（PTA） in Haidian District, The Third Hospital of Peking University （Haidian Hospital） from January 1 2020 to January 1 2021 as study. Results There were 187 males （55.8%） and 148 females （44.2%）. Kaplan-Meier survival analysis indicated that primary patency rates were 77.31% and 50.15% at Month 6/12 post-PTA. At Month 12 post-PTA, the risk of restenosis was significantly higher in AVG patients than that of AVF （Log-rank χ2 = 719.522, P＜0.001）. The risk of restenosis in patients with old lesions was significantly higher than that of those with new lesions （Log-rank χ2 = 23.106, P＜0.001）. The risk of restenosis in patients with local anesthesia was significantly higher than that of those with brachial plexus anesthesia （Log-rank χ2＝27.415, P＜0.001）. Multivariate Cox proportional risk regression analysis at Month 6 revealed that old/new lesions （HR = 0.393, 95%CI: 0.237-0.650, P＜0.001）, type/mode of anesthesia （HR = 3.223, 95%CI: 1.956-5.311, P＜0.001） and platelet count （HR = 1.005, 95%CI: 1.001-1.008, P = 0.008） were independent risk factors for restenosis post-PTA. Multivariate Cox proportional risk regression analysis at Month 12 indicated that type of fistula AVG （HR = 0.550, 95%CI: 0.387-0.782, P = 0.001）, old/new lesions （HR = 0.587, 95%CI: 0.422-0.815, P = 0.002） and type/mode of anesthesia （HR = 2.359, 95%CI: 1.686-3.302, P＜0.001） were independent risk factors for restenosis post-PTA. Conclusion Multiple factors may affect restenosis post-PTA in HD patients. And type/mode of anesthesia, old/new lesions and type of fistula are independent risk factors for restenosis post-PTA. Preoperative examinations and postoperative comprehensive follow-ups may prevent fistula dysfunction and help to formulate accurate surgical plans and conduct timely postoperative follow-ups.

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