J Korean Soc Radiol.  2013 Mar;68(3):205-211. 10.3348/jksr.2013.68.3.205.

The Impact of Anastomotic Angle for Re-Occlusion of Brachioaxillary Graft Arteriovenous Fistula after Percutaneous Thromboaspiration

• Kim KY
• Jin GY
• Hwang SB
• Choi EJ
• Song JS
• Han YM
• Kwon KS

• KMID: 1748452
• DOI: http://doi.org/10.3348/jksr.2013.68.3.205

Abstract

PURPOSE
The purpose of this study is to evaluate the factors that affect graft patency in brachioaxillary graft arteriovenous fistula patients.
MATERIALS AND METHODS
A retrospective study was conducted on 33 patients (20 men, 13 women; mean age, 67.5 years; mean interval to first stenosis, 17 months), who had performed percutaneous angioplasty for first episode of stenosis after brachioaxillary graft surgery. We evaluated the relevant factors affecting the graft patency after first episode of stenosis, such as age, sex, underlying disease (hypertension, diabetes mellitus, hyperlipidemia, cardiovascular disease, cerebrovascular attack), anastomotic angle between graft and axillary vein, and anastomotic angle between the graft and brachial artery. Kaplan-Meier method and log rank test and receiver operating characteristics curve analysis were used in statistical analysis.
RESULTS
Graft patency rates after 1 month, 6 months, and 12 months were 75.8%, 39.4%, and 9.1%. There was a correlation between graft-axillary vein anastomotic angle and patency rates (r = 0.372, p = 0.033); larger the venous anastomotic angle, the longer patency rate. However, it does not come up with significant results in patency rates on age, sex, underlying disease, and graft-brachial artery angle.
CONCLUSION
In patients with brachioaxillary graft arteriovenous fistula, as venous anastomotic angle more obtuse, the graft patency may be longer.

MeSH Terms

Anastomosis, Surgical
Angioplasty
Arteries
Arteriovenous Fistula
Axillary Vein
Brachial Artery
Cardiovascular Diseases
Constriction, Pathologic
Diabetes Mellitus
Humans
Hyperlipidemias
Male
Retrospective Studies
ROC Curve
Thrombectomy
Transplants
Vascular Patency
Veins

Figure

• 

  Fig. 1 Images from a 76-year-old male patient who had occlusive symptoms. It was first occlusion after arteriovenous fistula formation. He was treated for brachiaxillary type AVF graft occlusion. A. There is stenosis and thrombosis in venous anastomosis site on angiogram. The anastomotic angle is 21°. B. By using 6 mm-4 cm balloon catheter, balloon dilatation was performed to stenotic lesion. C. Thrombus within the graft was completely macerated and aspirated by using Arrow-Trerotola device. D. There is no stenosis and thrombosis in final angiogram. This patient's AVF primary patency was 19 days. Note.-AVF = arteriovenous fistula

• 

  Fig. 2 Images from a 41-year-old female patient. She was treated for brachiaxillary type arteriovenous fistula graft occlusion. A. Venous anastomotic site stenosis is shown on angiogram. The anastomotic angle is 60°. B. Balloon dilatation was performed. C. There is no stenosis in final venogram. Her primary patency was 650 days.

• 

  Fig. 3 Kaplan-Meier estimation of graft patency rates. The log rank test revealed a significantly longer graft patency for patients in whom venous side anastomotic angle is above 34.5°.

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