#462 Intimal hyperplasia rate as a predictor of hemodialysis arteriovenous fistula on the primary patency after percutaneous transluminal angioplasty

Abstract Background and Aims Percutaneous transluminal angioplasty (PTA) is an important method for evaluating hemodialysis dysfunction. We investigated factors associated with post-PTA primary patency rate in patients with arteriovenous fistula (AVF), including the intimal hyperplasia rate and previously reported factors. This study aimed to evaluate the effect of intimal hyperplasia rate on the outcomes of PTA for de novo dysfunctional AVF lesions. Method The medical records at Sichuan Provincial People’ s Hospital were collected to retrospectively identify and analyze general information, clinical characteristics, and hemodialysis-related factors for post-PTA primary patency in a cohort of 66 patients with AVF who underwent PTA after vascular access construction between January 2019 and December 2023. They were followed up for 12 months. When the patients needed to treat with PTA or AVF reconstruction due to re-occlusion, follow-up was terminated. The morphological assessment of stenotic lesion in dysfunctional AVF using ultrasound. Morphological assessment of stenotic lesion at the minimum lumen area site was conducted using ultrasound imaging to determine the intimal hyperplasia rate. The inner and outer diameters at the stenotic site were measured, and the intimal hyperplasia rate was calculated using the following formula: Intimal hyperplasia rate (%) = (outer diameter − inner diameter)/outer diameter. Results Multivariate analysis with the Cox proportional hazard model showed that post-PTA primary patency in patients with AVF is significantly associated with the intimal hyperplasia rate (hazard ratio 3785.345, 95% confidence interval 83.537 ∼ 171526.979, P < 0.001). ROC curve analysis showed that the intimal hyperplasia rate difference was statistically significant (AUC = 0.748, 95% confidence interval 0.630–0.866; P < 0.001) and had predictive value; the cut-off value of the intimal hyperplasia rate was 0.556. When the intimal hyperplasia rate was stratified into two categories, the risk of outcome events defining the end of post-PTA primary patency was significantly greater for >0.556 (hazard ratio 0.124, 95% confidence interval 0.029–0.527) than for <0.556 (P < 0.001). Conclusion The intimal hyperplasia rate is an important predictive factor for post-PTA primary patency in patients with AVF. Keywords Hemodialysis, patency, intimal hyperplasia rate, percutaneous transluminal angioplasty, arteriovenous fistula