title: Salvage of nonmaturing native fistulas by using angioplasty.
abstract: OBJECTIVE
  To retrospectively review outcomes following angioplasty of nonmaturing autogenous hemodialysis fistulas.
  
  
  METHODS
  Institutional review board exemption was received for this HIPAA-compliant retrospective study; informed consent was waived. During 48 months, 101 patients underwent fistulography for percutaneous salvage of nonmaturing native fistulas. Clinical and technical success, need for secondary interventions, and complications were recorded according to consensus definitions. Patency following angioplasty was estimated with the Kaplan-Meier technique. Patient age, sex, ethnicity, fistula age, fistula type, number of stenoses, maximal angioplastic balloon diameter used, and presence of palpable thrill following angioplasty were examined as predictors of primary patency of the fistula following intervention by using Cox proportional hazards model.
  
  
  RESULTS
  Mean patient age was 58 years; 35% were women. Median time from fistula creation to fistulography was 2.5 months. Hemodynamically significant (>50%) stenoses were identified in 88% (89 of 101) of patients; angioplasty was attempted in 96% (85 of 89). Technical success was achieved in 92% (78 of 85) of fistulas following angioplasty; clinical success of normal hemodialysis with total access blood flow of more than 500 mL/min occurred following 88% (75 of 85) of angioplastic interventions. No major and two minor complications occurred. Mean primary unassisted patency at 3, 6, and 12 months was 60%+/-6% (95% confidence interval), 45%+/-6%, and 34%+/-6%, respectively. Additional angioplasty (n=12), stent placement (n=1), or thrombectomy (n=1) during subsequent interventions resulted in mean secondary patency at 3, 6, and 12 months of 82%+/-4%, 79%+/-5%, and 75%+/-6%, respectively. Patients without thrill following angioplasty were more than twice as likely to lose patency as patients with thrill (P=.035). No relationship was seen between primary patency and other predictors examined.
  
  
  CONCLUSIONS
  Early fistulography enables identification of underlying areas of stenosis in nonmaturing fistulas, which can be safely and effectively treated with angioplasty. With continued surveillance and repeat interventions, functional patency can be sustained in the majority of fistulas.
authors.affiliation: Department of Radiology, Division of Interventional Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. timothy.clark@med.nyu.edu
authors.forename: Timothy W I
authors.initials: TW
authors.lastname: Clark
authors.forename: Raphael A
authors.initials: RA
authors.lastname: Cohen
authors.forename: Andrew
authors.initials: A
authors.lastname: Kwak
authors.forename: James F
authors.initials: JF
authors.lastname: Markmann
authors.forename: S William
authors.initials: SW
authors.lastname: Stavropoulos
authors.forename: Aalpen A
authors.initials: AA
authors.lastname: Patel
authors.forename: Michael C
authors.initials: MC
authors.lastname: Soulen
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Mondschein
authors.forename: Sidney
authors.initials: S
authors.lastname: Kobrin
authors.forename: Richard D
authors.initials: RD
authors.lastname: Shlansky-Goldberg
authors.forename: Scott O
authors.initials: SO
authors.lastname: Trerotola
mesh_terms: D017130:Angioplasty / Q000379:methods*; D005260:Female; D005402:Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome