title: Venous rupture during percutaneous treatment of hemodialysis fistulas and grafts.
abstract: OBJECTIVE
  The aim of this study was to analyze the risk and consequences of venous rupture during angioplasty of malfunctioning hemodialysis grafts and fistulas.
  
  
  BACKGROUND
  Venous stenoses in the outflow limb of hemodialysis accesses often require ultra-high balloon pressure for optimal dilatation.
  
  
  METHODS
  Baseline characteristics and outcomes were analyzed for a consecutive series of patients treated between 1999 and 2008.
  
  
  RESULTS
  Venous rupture or perforation occurred in 11 of 1242 (0.9%) procedures. No patient with a rupture or perforation died or required emergency or urgent surgical repair. Two of 11 patients (18.2%) required transfusions, 8 of 11 patients (72.7%) required stenting, and 6 of 8 (75.0%) who needed stenting received covered stents to achieve hemostasis. Rupture led to access thrombosis within 30 days in 9 of 11 cases (82%). Multivariable logistical regression analysis suggested that using a balloon catheter more than 2 mm larger than the diameter of the hemodialysis access or using peripheral cutting balloons increased the risk of rupture or perforation.
  
  
  CONCLUSIONS
  Rupture or perforation is a rare complication of treatment of malfunctioning hemodialysis grafts and fistulas. The complication may be managed with nonsurgical methods and might be avoided by optimal balloon selection and sizing.
authors.affiliation: Munroe Regional Medical Center, Ocala Heart Institute, Ocala, Florida, USA. jabittl@mac.com
authors.forename: John A
authors.initials: JA
authors.lastname: Bittl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects* / Q000295:instrumentation; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001803:Blood Transfusion; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D003251:Constriction, Pathologic; D004867:Equipment Design; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006489:Hemostatic Techniques; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010690:Phlebography; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D012421:Rupture; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014680:Veins / Q000293:injuries; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*