Endovascular salvage of nonmaturing autogenous hemodialysis fistulas: comparison with endovascular therapy of failing mature fistulas.
OBJECTIVE
To evaluate the utility of endovascular salvage of nonmaturing autogenous hemodialysis fistulas in a prospective trial of consecutive patients compared with a historical group of patients who underwent treatment of failing mature autogenous fistulas.


METHODS
During a 12-year period, angiography revealed anatomic lesions in 75 fistulas with maturing problems (72 radiocephalic and three brachiocephalic). Endovascular therapy through antegrade arterial access was attempted in 72 fistulas. A series of 45 consecutive patients who underwent endovascular salvage of failing mature fistulas was used as a control group.


RESULTS
A technical success rate of 88% (66 of 75) and a clinical success rate of 87% (65 of 75) were achieved for the nonmaturing fistulas. Including the secondary interventions, the rate of complications was 6.1% (eight of 131). By Kaplan-Meier analysis, the primary clinical patency rates were 43% +/- 6% (+/-SEM), 36% +/- 6%, and 23% +/- 6%, and the secondary patency rates were 76% +/- 5%, 68% +/- 6%, and 57% +/- 8% at 6, 12, and 36 months, respectively. A small inflow artery (<3 mm in diameter) predicted a poorer primary patency rate (28% +/- 10% vs 48% +/- 9% at 1 year; P = .01). The secondary patency rate of nonmaturing fistulas at 3 years was worse than that of mature fistulas, at 57% +/- 8% versus 79% +/- 8% (P = .02).


CONCLUSIONS
A functional fistula was achieved in 87% of nonmaturing fistulas. Although the functional time gained in these fistulas is shorter than that gained in failing mature fistulas, more than half of nonmaturing fistulas are functional after 3 years.
Manninen
Hannu I
HI
Department of Clinical Radiology, Kuopio University Hospital and Kuopio University, Puijonlaaksontie 2, FI-70210 Kuopio, Finland. hannu.manninen@kuh.fi
Kaukanen
Erkki
E
Mäkinen
Kimmo
K
Karhapää
Pauli
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D000800:Angioplasty, Balloon; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging / Q000601:surgery; D016009:Chi-Square Distribution; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome; D014654:Vascular Patency