目的 对于动静脉内瘘顽固性狭窄病变，采取递进处置策略进行干预治疗，分析该方案治疗的预后，旨在探讨更为有效合理的动静脉内瘘维护手段。 方法 回顾性分析2020年6月—2021年6月在南京医科大学第二附属医院血液净化中心因高位自体动静脉内瘘(autologous arteriovenous fistula，AVF)头静脉弓狭窄和人工血管动静脉内瘘(arteriovenous graft，AVG)静脉吻合口区域狭窄首次行超声引导经皮腔内血管成形术(percutaneous transluminal angioplasty，PTA)治疗，并采取递进处置策略维护的患者，随访24个月观察内瘘的通畅和再干预情况，另与南京医科大学第二附属医院血液净化中心同类病变单纯以高压球囊维护的随访数据比较得出结论。 结果 高位AVF头静脉弓狭窄采取递进处置策略维护的患者31例，单纯以高压球囊扩张规律维护的患者16例，随访24个月，两者在再干预次数(t=4.461，P＜0.001)、再干预后平均通畅时间(t=3.550，P＜0.001)及PTA辅助通畅率(χ2=5.562，P=0.021)方面比较差异有统计学意义；AVG静脉吻合口区域狭窄采取递进处置策略维护的患者68例，单纯以高压球囊扩张规律维护的患者58例，随访24个月，两者在再干预次数(t=5.094，P＜0.001)及再干预后平均通畅时间(t=3.251，P=0.002)方面比较差异有统计学意义。 结论 采取递进处置策略，循序渐进地使用各种介入治疗器械以及手术方案处置动静脉内瘘顽固性狭窄病变可以提高PTA的通畅性，减少干预频次，改善预后。

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.