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

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.