Impact of the Causes of Arteriovenous Fistula Stenosis on the Patency Rate of Arteriovenous Fistula Following Percutaneous Transluminal Angioplasty

Objective: The aim of this study is to investigate the impact of the causes of arteriovenous fistula (AVF) stenosis on the 1-year primary patency rate of AVF following percutaneous transluminal angioplasty (PTA) and to identify the independent risk factors that affect vascular access patency post-PTA. Methods: In this investigation, we analyzed the clinical data of 78 patients who underwent successful PTA for dysfunctional autologous AVF in the Nephrology Department of our hospital between January 2020 and September 2022. The primary focus of this study was to observe the postoperative patency rate of AVF in these patients. Subsequently, the patients were categorized based on primary diseases, Charlson comorbidity index (CCI), AVF typing, and causes of AVF stenosis. The postoperative patency rates of AVF were then compared among the respective groups. To further analyze the relevant risk factors influencing vascular access patency following PTA, the Cox proportional hazard model was employed. Results: A total of 78 eligible patients who underwent PTA were included in this study revealing patency rates of 93%, 85%, 80%, and 72% at 3, 6, 9, and 12 months postoperatively, respectively. Analysis using the Kaplan-Meier curve indicated no significant association between the presence of diabetic nephropathy (p = 0.313) and AVF stenosis typing (p = 0.195) with post-PTA patency of AVF. However, the 1-year patency rate demonstrated notable differences, with higher rates observed in the CCI < 7 group compared with the CCI >= 7 group and similarly in the simple AVF stenosis group compared with the intimal hyperplasia group (p < 0.001). Furthermore, based on multivariate survival analysis (Cox regression model), the causes of AVF stenosis and CCI index were identified as independent risk factors influencing AVF patency following PTA (p < 0.05). Conclusion: Patients with intimal hyperplasia were found to have a higher likelihood of AVF restenosis compared with those with simple stenosis. Similarly, individuals with a high CCI were more prone to AVF restenosis than those with low CCI. The causes of AVF stenosis and CCI were identified as independent risk factors influencing vascular access patency following PTA.