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首页> 外文期刊>Vascular and endovascular surgery >Clinical Course of Hemodialysis Access After Initial Endovascular Intervention for Stenosis in Asian Renal Failure Patients
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Clinical Course of Hemodialysis Access After Initial Endovascular Intervention for Stenosis in Asian Renal Failure Patients

机译：脑膜炎血管内血管内患者血管内诊断后的临床进程，亚洲肾功能衰竭患者狭窄

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Background: Arteriovenous fistula (AVF) and arteriovenous fistula graft (AVG) access for hemodialysis can develop stenosis, eventually leading to thrombosis and access failure. Prompt endovascular intervention can salvage the access but restenosis does occur. Clinical course, restenosis pattern, and risk factors associated with initial stenosis of AVFs/AVGs in Asian hemodialysis patients were studied. Method: A retrospective study was conducted (January 2009-June 2012) on consecutive patients with renal failure who developed the first-time stenosis in the vascular access and were managed with endovascular intervention. One hundred fourteen patients (54 AVFs and 60 AVGs) were studied, and all clinical outcomes were recorded until October 2013. Results: The mean time from access creation to endovascular intervention for the first-time stenosis for patients with AVF and AVG was 23.5 (32.7 standard deviation [SD]) months and 12.5 (11.0) months, respectively. An average of 1.7 (range, 1-5) interventions were performed for AVFs, whereas 2.4 (range, 1-11) for AVGs (P = .008). Upon conclusion of the study, 23 patients with AVF survived with functional index access, whereas 10 passed away with a functional original access. The remaining 21 patients with AVFs failed, requiring new access, tunneled catheter, or peritoneal dialysis. Of the 60 patients with AVG, 6 survived and 8 died with functional index access; 46 required new access or other forms of dialysis (P = .000). Kaplan-Meier estimated that access patency and survival with functional access were significantly lower for AVGs than for AVFs after the first salvage intervention. Female patients had an increased risk of restenosis with both univariate (P = .016) and multivariate (P = .013) analysis. With univariate analysis (P = .039), patients with hyperlipidemia had a higher risk of developing restenosis in the vascular access. Conclusion: The clinical course and prognosis of failing AVFs and AVGs are distinct. The information on access prognosis and stenosis recurrence patterns will be helpful for patient counseling and planning of follow-up intervals, after the first-time intervention for access stenosis.
机译：背景：动静脉瘘（AVF）和动静脉瘘移植物（AVG）血液透析的接触能够发展狭窄，最终导致血栓形成和进入失败。迅速血管内干预可以挽救访问，但确实发生了再狭窄。研究了与亚洲血液透析患者AVFS / AVG的初始狭窄相关的临床过程，再狭窄模式和危险因素。方法：进行回顾性研究（2012年1月 - 2012年6月）在连续肾功能衰竭患者中，在血管进入中开发了第一次狭窄，并以血管内的干预进行管理。研究了一百十四名患者（54例AVF和60个AVG），并记录了所有临床结果，直到2013年10月。结果：AVF和AVG患者的腹腔内狭窄的进入创建对血管内干预的平均时间为23.5（ 32.7标准差[SD]）个月和12.5（11.0）个月。为AVFS进行平均1.7（范围，1-5）干预，而AVG的2.4（范围为1-11）（p = .008）。在该研究结束后，AVF的23名患者幸存下来，凭借功能指数获取，而10则通过功能原始访问。其余21例AVFS患者失败，需要新的访问，隧道导管或腹膜透析。在60例AVG，6例患者中，8名幸存和8人死于功能指数获取; 46所需的新访问或其他形式的透析（p = .000）。 Kaplan-Meier估计，AVG在第一次救死干预后的AVF可见的可通勤和生存率显着降低。女性患者随着单变量（P = .016）和多变量（P = .013）分析，患者的重新狭窄风险增加。通过单变量分析（p = .039），高脂血症患者在血管进入中发育恢复的风险较高。结论：失败的AVFS和AVG的临床过程和预后是不同的。关于进入狭窄的首次干预后，有关访问预后和狭窄复发模式的信息将有助于对患者咨询和计划进行后续间隔进行后续间隔。

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