Abstract: Objective  The efficacy and prognosis of refractory stenosis in vascular access treated with a progressive treatment strategy were evaluated in order to find out suitable and effective approaches to maintain patency of vascular access.  Methods  The patients with stenosis in autologous arteriovenous fistula (AVF) at a higher site in cephalic vein arch and those with stenosis in artificial arteriovenous graft (AVG) at the venous anastomosis area treated with ultrasound-guided percutaneous transluminal angioplasty (PTA) for the first time in the Blood Purification Center of The Second Affiliated Hospital of Nanjing Medical University during the period from June 2020 to June 2021 were retrospectively analyzed. Progressive treatment strategy was used to maintain the patency of blood access for hemodialysis. Their patency and re-intervention rates were followed up for 24 months. The efficacy of progressive treatment strategy was compared to the prognosis of the patients with similar stenosis lesions only treated with PTA in the same blood purification center.  Results  A total of 31 patients having stenosis in AVF at a higher site in cephalic vein arch used the progressive treatment strategy, and 16 patients having the similar stenosis used the high pressure balloon dilation alone. After 24 months of follow-up, there were statistical differences in re-intervention times (t=4.461, P<0.001), average patency period after re-intervention (t=3.550, P<0.001) and PTA assistant patency rate (χ2=5.562, P=0.021) between the two groups. A total of 68 patients having stenosis in AVG at the venous anastomosis area used the progressive treatment strategy, and 58 patients having the similar stenosis used the high pressure balloon dilation alone. After 24 months of follow-up, there were statistical differences in re-intervention times (t=5.094, P<0.001) and average patency period after re-intervention (t=3.251, P=0.002) between the two groups.  Conclusion The progressive treatment strategy used suitable endovascular instruments and surgical approaches step-by-step to treat the refractory stenosis in AVF or AVG gradually. This method increased the patency rate, reduced the re-intervention times, and improved the prognosis of the patients.

Key words: Arteriovenous fistula, Cephalic venous arch, Artificial arteriovenous graft venous anastomosis area, Dilation balloon catheter, Covered stent