Endovascular treatment of dysfunctional arteriovenous fistula in hemodialyzed patients — the results of one year follow-up
Abstract
Introduction. The arteriovenous fistula (AVF) dysfunction is a common reason for vascular access problem in chronically hemodialyzed patients. It is caused by stenosis or occlusion located either in inflow artery, anastomosis or outflow vein. Revascularization of these pathologies can be achieved in surgical or endovascular (PTA) manner. The aim of this study was to evaluate both immediate and late endovascular treatment results of dysfunctional fistulas in chronically hemodialyzed patients.
Material and methods. We included in our observation 106 patients with end stage renal disease, who un-derwent PTA within arteriovenous fistulas. We used conventional and unified techniques of endovascular therapy. Procedural results were evaluated after 1, 3, 6 and 12 months based on fistula sufficiency during hemodialysis.
Results. In 96 (90.6%) cases the initial result of PTA was good. We achieved improvement in blood flow through AVF and successful hemodialysis. In 10 cases (9.4%) results were not satisfactory. None of our patients developed neither worsening in the blood flow through AVF nor compromised blood circulation distally to AVF. No serious complications (MI, stroke, death) occurred during procedure or hospital stay. After 12 months, in 52 patients AVF were functioning properly. In 20 cases, because of fistula dysfunction, reintervention was necessary (primary patency 66%). Considering all patients, also these with successful reintervention, 69 AVF were functioning properly after 12 months (secondary patency 86%).
Conclusions. To conclude, the immediate and long-term PTA outcomes of arteriovenous fistulas with currently available techniques and equipment are satisfying. PTA is a safe manner of prolonging patency rate of AVF in patients requiring permanent hemodialysis.
Keywords: arteriovenous fistulahemodialysispercutaneous transluminal angioplastyrevascularization
References
- United States Renal Data System (2007) Annual Data Report. Bethesda, MD: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health.
- Machado S, Ferreira A, Lucas C, et al. Results of endovascular procedures performed in dysfunctional arteriovenous accesses for haemodialysis. Port J Nephrol Hypert. 2012; 26: 266–271.
- Chazan JA, London MR, Pono LM. Long-term survival of vascular accesses in a large chronic hemodialysis population. Nephron. 1995; 69(3): 228–233.
- Stevenson KB, Hannah EL, Lowder CA, et al. Epidemiology of hemodialysis vascular access infections from longitudinal infection surveillance data: predicting the impact of NKF-DOQI clinical practice guidelines for vascular access. Am J Kidney Dis. 2002; 39(3): 549–555.
- Swedberg SH, Brown BG, Sigley R, et al. Intimal fibromuscular hyperplasia at the venous anastomosis of PTFE grafts in hemodialysis patients. Clinical, immunocytochemical, light and electron microscopic assessment. Circulation. 1989; 80(6): 1726–1736.
- Miller PE, Carlton D, Deierhoi MH, et al. Natural history of arteriovenous grafts in hemodialysis patients. Am J Kidney Dis. 2000; 36(1): 68–74.
- Glanz S, Gordon DH, Butt KM, et al. The role of percutaneous angioplasty in the management of chronic hemodialysis fistulas. Ann Surg. 1987; 206(6): 777–781.
- Tan TLx, May KK, Robless PA, et al. Outcomes of endovascular intervention for salvage of failing hemodialysis access. Ann Vasc Dis. 2011; 4(2): 87–92.
- Marston WA, Criado E, Jaques PF, et al. Prospective randomized comparison of surgical versus endovascular management of thrombosed dialysis access grafts. J Vasc Surg. 1997; 26(3): 373–380.
- Vascular Access Work Group, Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006; 48 Suppl 1: S176–S247.
- Ng LJ, Chen F, Pisoni RL, et al. Hospitalization risks related to vascular access type among incident US hemodialysis patients. Nephrol Dial Transplant. 2011; 26(11): 3659–3666.
- Fistula First Catheter Last (FFCL) Workgroup Coalition. End Stage Renal Disease Network Coordinating Centre. http://www.fistulafirst.org/ (28.07.2014).
- Gotch FA, Sargent JA. A mechanistic analysis of the National Cooperative Dialysis Study (NCDS). Kidney Int. 1985; 28(3): 526–534.
- Basile C, Casino F, Lopez T. Percent reduction in blood urea concentration during dialysis estimates Kt/V in a simple and accurate way. Am J Kidney Dis. 1990; 15(1): 40–45.
- Manninen HI, Kaukanen E, Mäkinen K, et al. Endovascular salvage of nonmaturing autogenous hemodialysis fistulas: comparison with endovascular therapy of failing mature fistulas. J Vasc Interv Radiol. 2008; 19(6): 870–876.
- Ayez N, Fioole B, Aarts RA, et al. Secondary interventions in patients with autologous arteriovenous fistulas strongly improve patency rates. J Vasc Surg. 2011; 54(4): 1095–1099.
- Cohen A, Korzets A, Neyman H, et al. Endovascular interventions of juxtaanastomotic stenoses and thromboses of hemodialysis arteriovenous fistulas. J Vasc Interv Radiol. 2009; 20(1): 66–70.
- Miller GA, Hwang W, Preddie D, et al. Percutaneous salvage of thrombosed immature arteriovenous fistulas. Semin Dial. 2011; 24(1): 107–114.
- Natário A, Turmel-Rodrigues L, Fodil-Cherif M, et al. Endovascular treatment of immature, dysfunctional and thrombosed forearm autogenous ulnar-basilic and radial-basilic fistulas for haemodialysis. Nephrol Dial Transplant. 2010; 25(2): 532–538.
- Cho SKi, Han H, Kim SS, et al. Percutaneous treatment of failed native dialysis fistulas: use of pulse-spray pharmacomechanical thrombolysis as the primary mode of therapy. Korean J Radiol. 2006; 7(3): 180–186.
- Turmel-Rodrigues L, Pengloan J, Rodrigue H, et al. Treatment of failed native arteriovenous fistulae for hemodialysis by interventional radiology. Kidney Int. 2000; 57(3): 1124–1140.
- Shatsky JB, Berns JS, Clark TWI, et al. Single-center experience with the Arrow-Trerotola Percutaneous Thrombectomy Device in the management of thrombosed native dialysis fistulas. J Vasc Interv Radiol. 2005; 16(12): 1605–1611.
- Liang HL, Pan HB, Chung HM, et al. Restoration of thrombosed Brescia-Cimino dialysis fistulas by using percutaneous transluminal angioplasty. Radiology. 2002; 223(2): 339–344.
- Raynaud A, Novelli L, Bourquelot P, et al. Low-flow maturation failure of distal accesses: Treatment by angioplasty of forearm arteries. J Vasc Surg. 2009; 49(4): 995–999.
- Overbosch EH, Pattynama PM, Aarts HJ, et al. Occluded hemodialysis shunts: Dutch multicenter experience with the hydrolyser catheter. Radiology. 1996; 201(2): 485–488.
- Haage P, Vorwerk D, Wildberger JE, et al. Percutaneous treatment of thrombosed primary arteriovenous hemodialysis access fistulae. Kidney Int. 2000; 57(3): 1169–1175.
- Rajan DK, Clark TWI, Simons ME, et al. Procedural success and patency after percutaneous treatment of thrombosed autogenous arteriovenous dialysis fistulas. J Vasc Interv Radiol. 2002; 13(12): 1211–1218.
- Ozkan B, Güngör D, Yıldırım UM, et al. Endovascular stent placement of juxtaanastomotic stenosis in native arteriovenous fistula after unsuccessful balloon angioplasty. Iran J Radiol. 2013; 10(3): 133–139.
- Tordoir JHM, Bode AS, Peppelenbosch N, et al. Surgical or endovascular repair of thrombosed dialysis vascular access: is there any evidence? J Vasc Surg. 2009; 50(4): 953–956.
- Dapunt O, Feurstein M, Rendl KH, et al. Transluminal angioplasty versus conventional operation in the treatment of haemodialysis fistula stenosis: results from a 5-year study. Br J Surg. 1987; 74(11): 1004–1005.