摘要目的:探讨血液透析患者动静脉移植物内瘘（AVG）狭窄的发生情况、干预方式及效果。方法:回顾性分析2018年1月至2022年12月在郑州大学第一附属医院血液净化中心构建AVG患者的通路资料。分析AVG的通畅情况、通路事件干预情况、AVG狭窄的发生情况及不同干预方式的效果。结果:共纳入475例患者，男193例（40.6%），女282例（59.4%），年龄（55.5±11.8）岁。随访时间［ M（ Q1， Q3）］19（12，30）个月，AVG的初级、初级辅助、次级通畅时间分别为14（5，27）、27（13，55）及59（33，65）个月。共发生799 例次进行干预的通路事件，标化干预率为0.90次/患者年，其中431例次（53.9%，431/799）为狭窄。狭窄事件集中发生在207个AVG中。在临床资料完善的422例次AVG狭窄事件中，57.8%（244/422）为多部位狭窄，42.2 %（178/422）为单一部位狭窄；狭窄前三位的好发部位分别为静脉吻合口附近（47.6%，340/715）、静脉流出道（22.7%，162/715）、穿刺区域（20.0%，143/715）。在干预后随访资料完整的414例次狭窄干预中，376例次（90.8%，376/414）采用经皮腔内球囊扩张术进行干预，35例次（8.5%，35/414）植入覆膜支架，3 例次（0.7%，3/414）采用外科干预，临床成功率98.1%（406/414）。腔内介入干预后的初级通畅时间为6（4，12）个月。支架植入患者术后AVG的初级通畅时间优于支架植入术前一次单纯球囊扩张干预后的初级通畅时间［6（3，7）个月比3（1，4）个月， P=0.020］。 结论:狭窄是AVG最常见的并发症，好发部位依次为静脉吻合口附近、静脉流出道和穿刺区域。AVG狭窄干预有较高的临床成功率，但干预后初级通畅时间较短。支架植入术可改善球囊扩张效果较差的AVG狭窄的通畅时间。

abstractsObjective:To evaluate the prevalence, intervention methods and effect of arteriovenous graft (AVG) stenosis.Methods:The clinical data of patients who received AVG in the Blood Purification Center, the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2022 were retrospectively analyzed. The patency rate, prevalence and intervention effect of AVG stenosis were analyzed.Results:A total of 475 patients aged (55.5±11.8) years were included, and there were 193 male cases (40.6%) and 282 female cases (59.4%). The patients were followed up for [ M ( Q1, Q3)] 19 (12, 30) months, and the primary, assisted primary and secondary patency were 14 (5, 27), 27 (13, 55), and 59 (33, 65) months, respectively. There were 799 access events which needed intervention, with a total standardized intervention rate of 0.90 per patient-year. Totally, 431(53.9%, 431/799) stenosis events occurred in 207 AVG. Among 422 AVG stenosis events with complete clinical data, 57.8% (244/422) were multi-site stenosis and 42.2% (178/422) were single-site stenosis. The most common sites of stenosis were graft-vein anastomosis (47.6%, 340/715), venous outflows (22.7%, 162/715), and puncture zone (20.0%, 143/715). In the 414 stenosis with intact follow-up data, 90.8% (376/414) were treated by balloon angioplasty, 8.5% (35/414) received covered stent insertion, and 0.7% (3/414) were intervened by open surgery. Clinical success rate was 98.1% (406/414). The primary patency time after endovascular treatment was 6 (4, 12) months. Covered stent significantly increased post-intervention primary patency time compared withballoon angioplasty [6 (3, 7) months vs 3 (1, 4) months, P=0.020]. Conclusions:Stenosis is the most common complication of AVG, and the most common sites are graft-vein anastomosis, venous outflows, and puncture zone. Intervention of AVG stenosis has a high clinical success rate, and a relatively low post-intervention patency. Covered stent insertion improves the post-intervention patency of AVG, which has a poor effect using balloon expansion.