Abstract: 【Abstract】Objective To investigate the selection of puncture site after secondary percutaneous transluminal angioplasty (PTA) on the function of autologous arteriovenous fistula (AVF). Methods A total of 60 patients who underwent secondary PTA for AVF class II stenosis in our hospital were prospectively reviewed. They were randomly divided into experimental group, in which the puncture site was far from the dilated arterial end of the AVF outflow tract after PTA, and control group, in which the puncture site located at the dilated arterial end of the AVF outflow tract after PTA for 2 weeks. They were followed up for 12 months, and their
clinical data were collected. AVF pump-controlled blood flow, brachial artery blood flow, diameter of dilated vessel and blood flow in dilated vessel after PTA for 1, 3, 6 and 9 months as well as the survival time of the AVF after PTA were compared between the two groups. Results In experimental group and control group after PTA for 1, 3, 6 and 9 months, AVF pump-controlled blood flow was 230.22±12.29 vs. 227.26±11.28 (t=0.971, P=0.335) after one month, 230.36 ± 21.69 vs. 220.32 ± 20.37 (t=1.800, P= 0.077) after 3 months, 231.32 ± 19.31 vs. 210.42 ± 13.32 (t=4.026, P<0.001) after 6 months, and 231.32 ± 18.21 vs. 206.18 ± 16.22 (t=4.317, P< 0.001) after 9 months; brachial artery blood flow was 1260.62 ± 210.23 vs. 1235.56 ± 218.26 (t=0.452, P= 0.652) after one month, 1132.25±213.28 vs. 1028.34±217.25 (t=1.822, P=0.074) after 3 months, 1088.45±221.18 vs. 936.37± 219.36 (t=2.361, P=0.022) after 6 months, and 967.39± 219.22 vs. 729.61±217.18 (t=3.247, P=0.002) after 9 months; diameter of dilated vessel was 5.55±1.28 vs. 5.33±1.23 (t=0.678, P=0.499) after one month, 5.12 ± 1.36 vs. 4.67 ± 1.02 (t=1.409, P= 0.164) after 3 months, 5.06 ± 1.37 vs. 3.90 ± 1.56 (t=2.714, P=0.009) after 6 months, and 4.86±1.29 vs. 3.83±1.46 (t=2.245, P=0.031) after 9 months; blood flow in dilated vessel was 680.26 ± 38.66 vs. 678.14 ± 36.56 (t=0.218, P= 0.828) after one month, 672.11 ±137.63 vs. 623.23±135.51 (t=1.351, P=0.182) after 3 months, 638.21±135.24 vs. 510.37±131.62 (t=3.274, P=
0.002) after 6 months, and 621.27±136.23 vs. 502.87±132.12 (t=2.625, P=0.012) after 9 months. The AVF pump-controlled flow, brachial blood flow, diameter of dilated vessel, and blood flow in dilated vessel in the two groups had no differences after PTA for one and 3 months, but were significantly different after PTA for 6 and 9 months; The median patency period was similar between the two groups during the follow-up period (9.40 vs. 9.00, χ2=2.316, P=0.128), but had a trend of longer period in experimental group than in control group. Conclusion In patients undergoing secondary PTA for AVF, the puncture site should always be far
from the dilated vessel segment to facilitate the repair of endothelial cells and the preservation of function, patency and survival period of the AVF.

Key words: Percutaneous transluminal angioplasty, Internal fistula, Dilated blood vessel, Hemodialysis