Feasibility of trans-radial approach in percutaneous intervention for upper arm dialysis access.
BACKGROUND
This retrospective study evaluated the feasibility and efficacy of trans-radial intervention for upper arm dialysis access.


METHODS
This study retrospectively reviewed 165 trans-radial interventions performed for upper arm dialysis access in 101 patients. Sixty-nine patients had arteriovenous graft (AVG), and 32 had arteriovenous fistula (AVF). Balloon angioplasty was performed in 66 stenotic dialysis accesses and 99 thrombosed dialysis accesses. Thrombosed dialysis access was further managed by additional balloon thrombectomy with or without urokinase injection.


RESULTS
Procedural time was 46.7 +/- 25.5 minutes. Anatomic and clinical success rates were 89.7% and 84.2%, respectively. The rate of complications, most of which involved lesion rupture with contrast-media extravasation and distal embolism, was 9.7%. Pretreatment stenosis was more severe (p = 0.01) and the prevalence of total occlusion was higher (p < 0.01) in the AVG group than the AVF group. The success rate and complication rate did not statistically differ (p = 0.59). Additionally, the thrombosed group had a lower success rate (p = 0.02), a higher complication rate (p < 0.01) and a longer procedural time (p < 0.01) than the stenotic group.


CONCLUSIONS
Comparison with previous studies employing the traditional approach reveals that trans-radial intervention has a comparable success rate, procedural time and complication rate for upper arm dialysis access. Therefore, trans-radial intervention is a safe and feasible technique for upper arm dialysis access.
Lin
Yu-Sheng
YS
The Division of Cardiology, Chiayi Chang Gung Memorial Hospital, Chiayi School, Chang Gung Institute of Technology, Taiwan.
Lin
Pi-Chi
PC
Hsu
Jen-Te
JT
Chang
Shih-Tai
ST
Yang
Teng-Yao
TY
Cheng
Hui-Wen
HW
Chung
Chang-Min
CM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm; D001166:Arteriovenous Shunt, Surgical / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D002408:Catheters, Indwelling; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D055815:Young Adult