Artery-to-fistula diameter ratio as a predictor of target lesion primary patency in the juxta-anastomotic segment after percutaneous transluminal angioplasty.

BACKGROUND

Percutaneous Transluminal Angioplasty (PTA) is a frequently performed intervention for repairing dysfunctional arteriovenous fistula (AVF). However, there is few data on the predictive factors for target lesion primary patency (TLPP), especially in the juxta-anastomotic segment. Our study aims to explore the relationship between the artery-to-fistula diameter ratio and TLPP in patients with mature radiocephalic AVF after PTA.

METHODS

We conducted a retrospective analysis of 104 CKD patients who underwent PTA due to recurrent stenosis that only affected the juxta-anastomotic area of AVF. Existing clinical records for each patient were reviewed and included measurements of vascular diameters and documentation of comorbidities. Cox proportional hazard models and ROC curve analyses were then used to assess the predictive power of the A/F diameter ratio for TLPP.

RESULTS

The patients were divided into group A (n = 34, primary patency time <12 months) and group B (n = 70, primary patency time ⩾12 months), according to the primary patency time. The proportion of radial artery calcification and the A/F diameter ratio in group A were significantly higher than those in group B (p < 0.05). Multivariate analysis by Cox proportional hazard model indicated that TLPP in patients with AVF is significantly correlated with the A/F diameter ratio (HR 5.446, 95% CI 2.176-13.632; p < 0.001). When the A/F diameter ratio was stratified into two categories, the risk of outcome events defining the end of TLPP was significantly greater for >0.760 (HR 7.871, 95% CI 3.039-20.389) than for <0.760 (p < 0.001).

CONCLUSION

The ratio of A/F diameter is a valuable indicator for TLPP in patients with juxta-anastomotic segment stenosis in AVF anastomosis after PTA. This ratio may also serve as a reference for preoperative assessment, clinical decision-making, and follow-up strategies.