Endovascular interventions of juxtaanastomotic stenoses and thromboses of hemodialysis arteriovenous fistulas.
OBJECTIVE
To assess the primary and secondary patency rates for juxtaanastomotic stenoses, with or without superimposed thromboses, of arteriovenous hemodialysis fistulas treated with angioplasty and to compare it with National Kidney Foundation Dialysis Outcomes Quality Initiative treatment guidelines for stenosed and occluded arteriovenous fistulas (50% primary patency rate at 12 months).


METHODS
This study was a retrospective analysis, covering a period of 5(1/2) years. Forty-three hemodialysis patients were referred due to secondary fistula dysfunction, and angiography was diagnostic of a juxtaanastomotic lesion. Interventions consisted of standard angioplasty techniques along with thrombolysis and/or thrombectomy and intravascular stent placement as needed. Follow-up was performed at the attending dialysis center, and repeat angiography was performed as clinically required.


RESULTS
Immediate postprocedural angiography demonstrated an angiographic success rate of 98%. Clinical success, with at least one session of normal dialysis, occurred in 95% of interventions. Primary patency rates at 12 months for the stenosed and stenosed/thrombosed fistulas were 56% and 64%, respectively. Secondary patency rates at 12 months were 64% and 63%, respectively. Half of the stenosed fistulas were patent at 1.5 years, 28% were patent at 4 years, and 13% remained patent at 6 years. No major complications were documented. Four minor complications, which did not require therapy, were noted.


CONCLUSIONS
The results achieved are comparable to those reported for interventions at nonjuxtaanastomotic sites and exceed those quoted by the National Kidney Foundation Dialysis Outcomes Quality Initiative guidelines. Angioplastic interventions in a juxtaanastomatic area of arteriovenous fistulas are safe, promote prolonged patency, and postpone the need for surgical intervention or creation of a new fistula.
Cohen
Aenov
A
Vascular Interventional Unit, Department of Diagnostic Radiology, Hasharon Hospital, Rabin Medical Center, Petach Tikva, Israel.
Korzets
Asher
A
Neyman
Haim
H
Ori
Yaakov
Y
Baytner
Shlomo
S
Belenky
Alexander
A
Knieznik
Michael
M
Bachar
Gil N
GN
Atar
Eli
E
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000295:instrumentation; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011859:Radiography; D006435:Renal Dialysis; D012189:Retrospective Studies; D015607:Stents; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency