Adaptive remodeling of hypoplastic hemodialysis fistulas salvaged with angioplasty.
OBJECTIVE
The aim of this study was to determine whether immature hemodialysis fistulas undergo flow-induced adaptive remodeling after successful percutaneous angioplasty.


BACKGROUND
Approximately 50% of radiocephalic fistulas remain immature after surgery and cannot be used for hemodialysis. Small fistulas with anastomotic inflow stenoses may undergo salvage angioplasty, but the time course of outward remodeling after successful treatment has not been defined.


METHODS
Thirty-two of 39 patients (82%) with inaccessible, hypoplastic radiocephalic fistulas underwent attempted salvage angioplasty of inflow stenoses involving the arteriovenous anastomoses. Twenty patients experienced salvage of their fistulas and successfully underwent hemodialysis (51%).


RESULTS
Eleven patients had serial angiographic procedures, which allowed paired sequential quantitative angiographic measurements of the fistulas to be made during a median follow-up of 200 days (range 5-2,298 days). Fistula diameters increased from 4.5 +/- 1.3 mm to 8.0 +/- 2.5 mm (mean +/- S.D.). The mean growth of the fistulas was 1.0 +/- 0.9 mm per year.


CONCLUSIONS
The mechanism of adaptive remodeling transforms nonmaturing hypoplastic autogenous fistulas into functioning accessible dialysis accesses after successful percutaneous transluminal angioplasty of inflow anastomotic stenoses.
Bittl
John A
JA
Munroe Regional Medical Center, Ocala, Florida 34480, USA. jabittl@mac.com
von Mering
Gregory O
GO
Feldman
Robert L
RL
D000222:Adaptation, Physiological; D000800:Angioplasty, Balloon; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D003251:Constriction, Pathologic; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011859:Radiography; D012039:Regional Blood Flow; D006435:Renal Dialysis; D016879:Salvage Therapy; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency