Analysis of primary patency rate and influencing factors of ultrasound-guided percutaneous transluminal angioplasty for the treatment of arteriovenous fistula dysfunction.

BACKGROUND

Ultrasound-guided percutaneous transluminal angioplasty (UG-PTA) has become the preferred endovascular intervention for arteriovenous fistula dysfunction. However, long-term patency rates remain variable, and identifying key factors affecting outcomes is crucial for clinical decision-making.

METHODS

This retrospective study analyzed 173 patients who underwent UG-PTA for arteriovenous fistula dysfunction at Xuzhou Central Hospital between August 2018 and August 2022. Kaplan-Meier survival analysis was used to assess primary patency rates, and Cox proportional hazards modeling identified independent risk factors affecting patency duration.

RESULTS

The median primary patency time after initial PTA was 33.00 months (95% CI 24.76-41.25). The primary patency rates were 93.1% at 3 months, 83.2% at 6 months, 68.9% at 12 months, 55.0% at 24 months, 45.9% at 36 months, and 30.9% at 48 months. The mean secondary patency time was 56.30 months (95% CI 53.18-59.42), and the secondary patency rates were 92.3% at 12 months, 90.2% at 24 months, 85.0% at 36 months, and 82.3% at 48 months. Native arteriovenous fistulas (AVFs) showed significantly longer patency than grafts (AVGs) (36 vs 6 months, p < 0.001). Multivariate analysis identified the degree of feeding artery calcification, lesion location, and access type (AVF vs. AVG) as independent factors affecting primary patency. With regular UG-PTA surveillance, secondary patency remained 82.3% at 48 months.

CONCLUSION

Vascular calcification burden and access type are key determinants of UG-PTA outcomes. High-risk patients (e.g., those with AVGs or significant feeding artery calcification) may benefit from intensified surveillance and individualized intervention protocols.