Immediate hemodialysis after percutaneous transvenous angioplasty increases patency rates of arterio-venous fistula.
BACKGROUND
It was reported that pathogenesis of access failure of hemodialysis patients through progressive stenosis was followed by thrombosis. Nonionic contrast media increase platelet degranulation within an angioplasty-damaged vessel by releasing procoagulant molecules, which might contribute to acute thrombosis and restenosis. An adequate level of heparin provides satisfactory thrombin inhibition during routine angioplasty. This study was performed to evaluate the effect of immediate hemodialysis after percutaneous transvenous angioplasty (PTA) to remove nonionic contrast media or other factors while injecting heparin continuously.


METHODS
From September 9, 1998 - May 15, 2002, successful PTAs were performed in 66 patients with arteriovenous fistula who were not given any inhibitors of platelet aggregation. Hemodialysis was performed in 31 cases immediately after PTA, and in the remainder, hemodialysis was performed the next day. Patients were randomized and fistula patency rates were compared in these 2 groups on March 20, 2004.


RESULTS
The patency rates after PTA in patients who were dialyzed immediately, were significantly higher than those who were dialyzed the next day (p = 0.0120).


CONCLUSIONS
Immediate hemodialysis after PTA is an effective way of increasing the patency of arteriovenous fistula for reasons which are not clear. This observation will need to be corroborated in subsequent studies using a larger sample size.
Ono
T
T
Renal Division, Saiseikai Yahata General Hospital, 5-9-27 Harunomachi, Yahatahigashiku, Kitakyushu 805-0050, Japan. taka-ono@yf6.so-net.ne.jp
Goto
H
H
Morishita
K
K
Kondo
H
H
Hirakata
H
H
Iida
M
M
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001166:Arteriovenous Shunt, Surgical; D003251:Constriction, Pathologic / Q000209:etiology; D003287:Contrast Media / Q000009:adverse effects; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D013927:Thrombosis / Q000150:complications; D013997:Time Factors; D014654:Vascular Patency
D000925:Anticoagulants; D003287:Contrast Media; D006493:Heparin