title: [Does early vascular access intervention therapy reduce acute obstruction and reconstruction of arterial-venous fistula?].
abstract: Acute vascular access (VA) obstruction is one of the most common complications for hemodialysis patients and medical professions. We performed early vascular access intervention therapy (VAIVT) to reduce the incidence of acute VA obstruction, VAIVT and fistula reconstruction. During a 2-year period, we performed 125 procedures of VAIVT in 145 cases in 50 patients who underwent arterio-venous fistula angiography. We performed early VAIVT within two weeks since we clinically found VA stenosis. The 125 procedures of VAIVT (95 non-thrombosed cases, 30 thrombosed cases) involved 86 native fistulas (74 non-thrombosed, 12 thrombosed) and 39 graft fistulas (21 non-thrombosed, 18 thrombosed). Prevalence of thrombosed cases was significantly higher in graft fistula than in native fistula (P<0.001). The primary patency rate in 50 patients at 6, 12 and 24 months was 62.1, 46.9 and 41.7%, respectively, while the secondary patency rate was 93.7, 90.7 and 86.6%, respectively. The highest primary patency rate was found in the non-thrombosed group with native fistula and the lowest secondary patency rate was found in the thrombosed group with graft fistula. By comparing the results of this study with the events for the previous 2 years, the total VAIVT number was almost the same. The number of non-thrombosed cases increased significantly from 54 to 95, and those of thrombosed cases decreased from 68 to 30 (P < 0.001). The number of fistula reconstructions significantly decreased from 59 to 22 (P<0.001). Early VAIVT for VA stenosis could decrease acute VA obstruction and fistula reconstruction without increasing the total number of VAIVT.
authors.affiliation: The Department of Urology, Graduate School of Medicine, Gifu University.
authors.forename: Toru
authors.initials: T
authors.lastname: Yamada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kondo
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Doi
authors.forename: Shinichi
authors.initials: S
authors.lastname: Itoh
authors.forename: Naoki
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Ehara
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Minamidate
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ishihara
authors.forename: Takashi
authors.initials: T
authors.lastname: Deguchi
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon; D001166:Arteriovenous Shunt, Surgical; D002408:Catheters, Indwelling / Q000009:adverse effects*; D048909:Diabetes Complications / Q000150:complications; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D006435:Renal Dialysis / Q000009:adverse effects*; D014654:Vascular Patency