Preliminary study of various approaches to endovascular intervention for ultrasound-guided arteriovenous fistula stenosis

Objective To observe the relationship between endovascular approach and arteriovenous fistula (AVF)stenosis,discuss the basic principles of approach to endovascular intervention under ultrasonic guidance and provide practical and sound strategies for AVF stenosis.Methods From January 1,2017 to December 31,2019,patients receiving endovascular intervention under ultrasonic guidance for autologous AVF stenosis at Municipal Haidian Hospital were selected.Basic patient data,such as site,direction,complications of approach and outcomes,were retrospectively collected.And the relationship between endovascular approach and AVF stenosis was analyzed by Spearman’s correlation.Results A total of 521 patients underwent 693 (percutaneous transluminal angioplasty)PTA sessions.Anastomotic region stenosis predominated (38.24%);outflow venous stenosis (31.60%),inflow arterial stenosis (23.37%,including heel stenosis 9.67%) and over two stenoses (6.78%).A total of 768 approaches were established,including outflow vein approach (88.31%),dual approach of brachial artery & outflow vein (7.50%) and dual approach of outflow vein (3.32%).And dual approach of brachial & distal radial artery was relatively rare.Technical success rate of PTA was 96.68% and clinical success rate 96.39%.The incidence of approach-related complications was 4.96%.Spasticity (3.43%) and hematoma (1.78%)predominated.Outflow venous hematomas and spasm occurred at areas without puncture history.The technical success rate of PTA for inflow artery heel stenosis was 97.92% and the incidence of approach-related complications 2.08%.The dual approach of brachial artery and outflow vein was significantly correlated with inflow artery heel stenosis (correlation coefficient 0.606,P<0.01).Conclusions Outflow vein is a first choice for ultrasound-guided endovascular intervention of AVF stenosis.For complicated lesions,especially those with inflow arterial heel stenosis,dual approach of brachial artery and outflow vein is considered.