title: Prophylactic angioplasty reduces thrombosis in virgin ePTFE arteriovenous dialysis grafts with greater than 50% stenosis: subset analysis of a prospectively randomized study.
abstract: OBJECTIVE
  To determine if prophylactic percutaneous transluminal balloon angioplasty (PTA) can extend patency in functioning virgin ePTFE arteriovenous hemodialysis grafts.
  
  
  METHODS
  The results of a prospectively randomized study of 64 patients with greater than 50% stenosis of functioning ePTFE arteriovenous hemodialysis grafts who were blindly assigned to be treated with PTA (treatment group) or observed without treatment (control group) were subjected to statistical subset analysis. Within this group were 21 patients (virgins) who had never undergone surgery, PTA, or thrombolysis. Eight patients had been assigned to the treatment group and 13 to the control group. The virgin groups were well matched as to age, sex, and risk factors. The virgin treatment group versus virgin control group had 1.63 versus 1.46 stenoses per patient and 61.3% versus 63.3% average percentage stenosis per lesion, respectively. Stenoses were treated with PTA 27 times (average, 3.4 per patient) in the virgin treatment group. Primary study patency began at the time of randomization and ended with graft thrombosis or nonfunction.
  
  
  RESULTS
  Among the 32 patients randomized to treatment with PTA, study patency was significantly increased (P > .0001) and the incidence of graft thrombosis significantly decreased (P = .0151) in the eight-patient virgin subset when compared with the 24-patient nonvirgin subset of the treatment group. During the 81.3 patient-dialysis-year study period, patency in the virgin-treatment versus virgin-control groups, respectively, was terminated by thrombosis in two versus nine, by death in two versus two, and cadaveric renal transplant in one versus zero. There was a statistically significant prolongation of study patency (P = .0349) and a reduction of graft thromboses, 0.10 versus 0.44 thromboses per patient-dialysis year, in the virgin-treatment group compared to the virgin-control group.
  
  
  CONCLUSIONS
  Patency after PTA of ePTFE hemodialysis grafts is significantly affected by previous interventions. Prophylactic PTA of stenoses greater than 50% in functioning virgin ePTFE arteriovenous hemodialysis grafts can significantly extend their patency. PTA should be included as an important treatment option in this patient population.
authors.affiliation: Emory University School of Medicine, Section of Cardiovascular and Interventional Radiology, Atlanta, GA USA.
authors.forename: L G
authors.initials: LG
authors.lastname: Martin
authors.forename: M J
authors.initials: MJ
authors.lastname: MacDonald
authors.forename: D
authors.initials: D
authors.lastname: Kikeri
authors.forename: G A
authors.initials: GA
authors.lastname: Cotsonis
authors.forename: L A
authors.initials: LA
authors.lastname: Harker
authors.forename: A B
authors.initials: AB
authors.lastname: Lumsden
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000800:Angioplasty, Balloon; D001166:Arteriovenous Shunt, Surgical / Q000295:instrumentation*; D001807:Blood Vessel Prosthesis; D016022:Case-Control Studies; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000517:prevention & control*; D006801:Humans; D016030:Kidney Transplantation; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011446:Prospective Studies; D006435:Renal Dialysis / Q000295:instrumentation*; D012307:Risk Factors; D016037:Single-Blind Method; D013927:Thrombosis / Q000517:prevention & control*; D014654:Vascular Patency
chemical_list: D011138:Polytetrafluoroethylene