title: Incidence and management of percutaneous transluminal angioplasty-induced venous rupture in the "fistula first" era.
abstract: OBJECTIVE
  Percutaneous transluminal angioplasty (PTA)-induced venous rupture is a common complication of hemodialysis access interventions. The authors sought to determine if venous rupture rates and management differed between grafts and fistulas, and in the fistula subset, between transposed and nontransposed fistulas.
  
  
  METHODS
  Patients experiencing venous rupture during hemodialysis PTA over a 5-year period were identified. Of 1,985 hemodialysis interventions, 75 ruptures occurred in 69 patients (46 women) with a mean age of 63 years (range, 31-88 y). Rupture rates, proportion of successful treatments, and treatment type and number (ie, balloon tamponade, stent, covered stent) were determined.
  
  
  RESULTS
  Rupture was more common in fistulas overall (5.6%, 39 of 693) compared with grafts (2.8%, 36 of 1,292; P = .002), in transposed (10.7%, 20 of 187) compared with nontransposed fistulas (3.8%, 19 of 506; P = .001), and in transposed fistulas compared with grafts (P = .0001). There was no significant difference between nontransposed fistulas and grafts. Treatment success (ie, resolution of extravasation) was the same among groups: 69% (27 of 39) in fistulas overall, 70% (14 of 20) in transposed fistulas, 68% (13 of 19) in nontransposed fistulas, and 72% (26 of 36) in grafts. There was a greater need for stents in grafts (38.9%, 14 of 36) compared with fistulas (12.8%, five of 39; P = .003).
  
  
  CONCLUSIONS
  PTA-induced rupture is more common in fistulas than grafts, and this effect seems nearly entirely driven by transposed fistulas. Although rupture treatment in fistulas of all types yielded similar success to grafts, and graft ruptures were more difficult to treat than fistula ruptures, the high rupture rates in transposed fistulas attest to the increased difficulty of treating this subset of fistulas.
authors.affiliation: Department of Radiology, Division of Interventional Radiology, University of Pennsylvania Medical Center, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors.forename: Zev Noah
authors.initials: ZN
authors.lastname: Kornfield
authors.forename: Andrew
authors.initials: A
authors.lastname: Kwak
authors.forename: Michael C
authors.initials: MC
authors.lastname: Soulen
authors.forename: Aalpen A
authors.initials: AA
authors.lastname: Patel
authors.forename: Sidney M
authors.initials: SM
authors.lastname: Kobrin
authors.forename: Raphael M
authors.initials: RM
authors.lastname: Cohen
authors.forename: Mark D
authors.initials: MD
authors.lastname: Mantell
authors.forename: Jesse L
authors.initials: JL
authors.lastname: Chittams
authors.forename: Scott O
authors.initials: SO
authors.lastname: Trerotola
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012421:Rupture / Q000453:epidemiology; D016896:Treatment Outcome; D014680:Veins / Q000293:injuries* / Q000601:surgery*