title: Interventional radiology in hemodialysis fistulae and grafts: a multidisciplinary approach.
abstract: OBJECTIVE
  To review the place of interventional radiology in arteriovenous access for hemodialysis.
  
  
  METHODS
  Prophylactic dilation of stenoses greater than 50% associated with clinical abnormalities such as flow-rate reduction is warranted to prolong access patency. Stents are placed only in selected cases with clearly insufficient results of dilation but they must never overlap major side veins and obviate future access creation. Thrombosed fistulae and grafts can be declotted by purely mechanical methods or in combination with a lytic drug.
  
  
  RESULTS
  The success rates are over 90% for dilation, with frequent resort to stents in central veins. Long-term results in the largest series are better in forearm native fistulae compared with grafts (best 1-year primary patency: 51% versus 40%). The success rates for declotting are better in grafts compared with forearm fistulae but early rethrombosis is frequent in grafts so that primary patency rates can be better for native fistulae from the first month's follow-up (best 1-year primary patency: 49% versus 26%).
  
  
  CONCLUSIONS
  Radiology achieves results comparable with surgery, with minimal invasiveness and better venous preservation. However, wide variations in the results suggest that the degree of commitment of physicians might be as important as the type of technique used.
authors.affiliation: Department of Cardiovascular Radiology, Clinique St-Gatien, Place de la Cathedrale, F-37000 Tours, France. luc.turmel@wanadoo.fr
authors.forename: Luc
authors.initials: L
authors.lastname: Turmel-Rodrigues
authors.forename: Josette
authors.initials: J
authors.lastname: Pengloan
authors.forename: Pierre
authors.initials: P
authors.lastname: Bourquelot
mesh_terms: D000800:Angioplasty, Balloon; D001166:Arteriovenous Shunt, Surgical; D001807:Blood Vessel Prosthesis; D003251:Constriction, Pathologic / Q000628:therapy; D006083:Graft Occlusion, Vascular / Q000628:therapy*; D006801:Humans; D015642:Radiology, Interventional; D006435:Renal Dialysis; D015607:Stents; D013927:Thrombosis / Q000628:therapy*; D014654:Vascular Patency