Korean Circ J.  2011 Sep;41(9):512-517. 10.4070/kcj.2011.41.9.512.

The Primary Patency of Percutaneous Transluminal Angioplasty in Hemodialysis Patients With Vascular Access Failure

• Kim WS
• Pyun WB
• Kang BC

• KMID: 2094103
• DOI: http://doi.org/10.4070/kcj.2011.41.9.512

Abstract

BACKGROUND AND OBJECTIVES
Dysfunction of arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) contributes significantly to morbidity and hospitalization in the dialysis population. We evaluated the primary patency of AVFs following percutaneous transluminal angioplasty (PTA) in haemodialysis patients.
SUBJECTS AND METHODS
We performed 231 interventions in 118 patients with a mean age of 62.1+/-12.9 years. We performed 122 interventions in 53 AVG patients (44.9%), and 109 interventions in 65 AVF patients (55.1%). If there was thrombosis of the vascular access, urokinase was administered and/or thrombus aspiration was performed. The stent was inserted when balloon dilatation did not expand sufficiently or elastic recoil occurred.
RESULTS
For the 118 patients, the median patency time was 10.45+/-10.29 months at 92 months of follow-up. The primary patencies for stenotic AVFs at 6, 12, 24, 36, 48, and 60 months were 63.4%, 41.4%, 17.0%, 9.7%, 7.3%, and 2.4%, respectively. The primary patencies for AVGs at 6, 12, 24, and 36 months were 36.9%, 19.5%, 10.8%, 2.1%, respectively, and were obtained by means of the Kaplan-Meier analysis (log rank=6.42, p<0.05). The median patency time was 11.0 months and 4.45 months in the non-thrombus and thrombus groups, respectively. The complication rate was 1.73% (4/231); two cases of pseudoaneurysms and two cases of extravasation were detected. All therapy failures (5/231) occurred in thrombotic lesions of AVGs and were treated surgically.
CONCLUSION
PTA is an efficacious method for the correction of stenosis of AVFs for hemodialysis, thus prolonging the patency of the fistulas.

Keyword

Arteriovenous fistulas; Percutaneous transluminal angioplasty; Dialysis

MeSH Terms

Aneurysm, False
Angioplasty
Arteriovenous Fistula
Constriction, Pathologic
Dialysis
Dilatation
Fistula
Follow-Up Studies
Hospitalization
Humans
Kaplan-Meier Estimate
Renal Dialysis
Stents
Thrombosis
Transplants
Urokinase-Type Plasminogen Activator
Urokinase-Type Plasminogen Activator

Figure

• 

  Fig. 1 A severe stenotic lesion. A: stenosis in the anastomotic fistulae between the brachial artery and basilic vein. B: a waist in the 14 mm length balloon is seen. C: percutaneous transluminal angioplasty with 16 mm length balloon. D: post-angioplasty injection shows near resolution of the stenosis.

• 

  Fig. 2 Thrombosed fistula. A: fistulogram shows a total occlusion involving a thrombus at the arterial anastomosis of a brachial-axillary dialysis graft. B: angiogram shows the balloon inflated at the diseased segment. C: angiogram after ballooning shows insufficient dilatation and residual clots. D: radiograph shows that an Arrow-Trerotola percutaneous thrombolytic device is used at the lesions of clots. E: final angiography shows no residual clots and confirmed an excellent result.

• 

  Fig. 3 Primary patency rates of AVFs and AVGs (p<0.05). AVF: arteriovenous fistula, AVG: arteriovenous graft.

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  Fig. 4 Primary patency rate in the thrombus group and non-thrombus group (p<0.001).

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