Percutaneous transluminal angioplasty for Brescia-Cimino hemodialysis fistula dysfunction: technical success rate, patency rate and factors that influence the results.
OBJECTIVE
To evaluate the initial clinical success and long-term patency rates of percutaneous transluminal angioplasty (PTA) using a venous approach for dysfunctional Brescia-Cimino fistula and to identify factors that may affect initial success and long-term patency.


METHODS
A total of 99 PTA procedures were performed in retrograde fassion for 60 mature Brescia-Cimino shunts with dysfunction caused by anastomotic or peripheral outflow vein stenosis or occlusion. The initial clinical success rates were compared between stenosis and occlusion using Fisher's exact test. The Kaplan-Meier method was used to calculate the primary and secondary cumulative patency rates, and the log-rank test was used for comparison. Relative risks of patency loss according to clinical characteristics were determined with multivariate Cox models.


RESULTS
The initial clinical success rate of all interventions was 92%, and the rates for stenosis and occlusion were 99 and 65%, respectively (P < 0.0001). The primary and secondary cumulative patency rates for fistulas (excluding initial failure) at 12 months were 53 and 84%, respectively. The relative risks were 5.2 (P = 0.004) for longer lesions and 4.5 (P = 0.007) for younger fistulas. The primary cumulative patency rate of four patients with a younger fistula and a longer stenosis at 4 months was 0%.


CONCLUSIONS
Favorable primary and secondary cumulative patency rates are obtained in most patients. Long lesion length and younger age of fistulas were the two factors that reduced the patency rate after PTA.
Maeda
Kiyosumi
K
Department of Radiology, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu-city, Shiga 520-2192, Japan. kiyosumi@belle.shiga-med.ac.jp
Furukawa
Akira
A
Yamasaki
Michio
M
Murata
Kiyoshi
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D001166:Arteriovenous Shunt, Surgical; D005260:Female; D006083:Graft Occlusion, Vascular / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D016896:Treatment Outcome; D014654:Vascular Patency