[Radiologic restoration of patency in arteriovenous fistulas and grafts for vascular access in hemodialysis: the learning curve].
OBJECTIVE
To demonstrate the importance of the learning curve in the restoration of patency in vascular accesses (native fistulas and grafts) that are "plugged" on reaching the vascular radiology suite.


METHODS
We present our experience in restoring patency in 47 vascular accesses for hemodialysis (36 native fistulas and 11 grafts) that stopped functioning abruptly. In those cases in which the cause was stenosis, we dilated the vessel with an angioplasty balloon. If thrombotic material was present in the access, we tried using different techniques to treat the thrombus until manual aspiration using a catheter was decided on as the definitive technique in the last 20 cases.


RESULTS
A total of 53 lesions were treated, 39 of which contained thrombotic material. The overall rate of success was 63.8% (30 accesses restored). The best results in the removal of thrombotic material were obtained by manual aspiration of the thrombus using a catheter (90% success). Overall patency rates at 6 and 12 months were 18 and 9%, respectively. At the end of the follow-up period, 16 (53%) of the 30 accesses restored were functioning.


CONCLUSIONS
In our experience, the restoration of patency in fistulas or grafts for hemodialysis requires special learning on the part of the vascular radiologist. When thrombotic material is present, we believe that manual aspiration using a catheter is the technique that yields the best results and at a lower cost.
García Medina
José
J
Servicio de Radiología Intervencionista, Hospital Universitario Virgen de la Arrixaca, Murcia, España. josegmedina@seram.org
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical; D002408:Catheters, Indwelling; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D011859:Radiography; D006435:Renal Dialysis; D013927:Thrombosis / Q000000981:diagnostic imaging; D014652:Vascular Diseases / Q000000981:diagnostic imaging* / Q000628:therapy*; D014654:Vascular Patency