Percutaneous intervention in axillary loop-configured arteriovenous grafts for chronic hemodialysis patients.
OBJECTIVE
The purpose of this study was to evaluate the fistulographic features of malfunctioning axillary loop-configured arteriovenous grafts and the efficacy of percutaneous interventions in failed axillary loop-configured arteriovenous grafts.


METHODS
Ten patients with axillary loop-configured arteriovenous grafts were referred for evaluation of graft patency or upper arm swelling. Fistulography and percutaneous intervention, including thrombolysis, percutaneous transluminal angioplasty and stent placement, were performed. Statistical analysis of the procedure success rate and the primary and secondary patency rates was done.


RESULTS
Four patients had graft related and subclavian venous stenosis, two patients had graft related stenosis and another four patients had subclavian venous stenosis only. Sixteen sessions of interventional procedures were performed in eight patients (average: 2 sessions / patient) until the end of follow-up. An interventional procedure was not done in two patients with central venous stenosis. The overall procedure success rate was 69% (11 of 16 sessions). The post-intervention primary and secondary patency rates were 50% and 63% at three months, 38% and 63% at six months and 25% and 63% at one year, respectively.


CONCLUSIONS
Dysfunctional axillary loop-configured arteriovenous grafts almost always had subclavian venous and graft-related stenosis. Interventional treatments are helpful to overcome this and these treatments are expected to play a major role in restoring and maintaining the axillary loop-configured arteriovenous loop grafts.
Park
Beom Jin
BJ
Department of Radiology, College of Medicine, Korea University, Seoul 136-705, Korea.
Kim
Hyoung Rae
HR
Chung
Hwan Hoon
HH
Sung
Deuk Jae
DJ
Park
Sang Joon
SJ
Son
Ho Sung
HS
Jo
Sang Kyung
SK
Kim
Yun Hwan
YH
Cho
Sung Bum
SB
D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods*; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002908:Chronic Disease; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D013350:Subclavian Vein / Q000000981:diagnostic imaging; D016019:Survival Analysis; D016896:Treatment Outcome; D014463:Ultrasonography; D014654:Vascular Patency