title: Outcome of immediate interventions in acute dysfunctional hemodialysis fistulas.
abstract: OBJECTIVE
  To analyze the efficacy of interventions in acute dysfunctional hemodialysis fistulas, if intervention is performed immediately as recommended by European Best Practice Guidelines for Hemodialysis.
  
  
  METHODS
  Over 3 years, all (n = 280) patients with an acute dysfunctional hemodialysis fistula were immediately referred to angiography, irrespective of the time of day. Angiography and, if possible, interventional revision (n = 241) were performed. Three groups of interest were established: interventionalist's experience (high/low), time of day (routine hours: 7 am-4 pm/emergency hours: 4 pm-7 am), lesion type (stenosis/fibrosclerotic occlusion/thrombotic occlusion/combined stenosis+thrombotic occlusion). For statistical analysis corresponding success rates, chi-square tests (p < 0.025) and logistic regression analysis (p < 0.05) were calculated.
  
  
  RESULTS
  The total success rate was 62 % (149/241). The success rates were: interventionalist experience high/low 71 % (79/111)/54 % (70/130), p = 0.022; time of day routine/emergency hours 68 % (93/136)/53 % (56/105), p = 0.017; lesion type stenosis/fibrosclerotic occlusion/thrombotic occlusion/combined stenosis+occlusion 82 % (94/104)/39 % (13/33)/18 % (6/33)/59 % (36/61), p < 0.001. Relevant variables due to logistic regression analysis were high experience and the lesion types stenosis and combined stenosis+occlusion with odds ratios 2.300 (p = 0.012), 12.053 (p < 0.001), 3.189 (p = 0.003).
  
  
  CONCLUSIONS
  Unrestricted implementation of immediate interventions in acute dysfunctional hemodialysis fistulas requires permanent availability of experienced interventionalists. The lesion types fibrosclerotic occlusion and thrombotic occlusion offer poor success rates for interventional revision.
authors.affiliation: Diagnostic Radiology, University Hospital Schleswig-Holstein Campus Kiel, Kiel. jostphilipp@web.de
authors.forename: P J
authors.initials: PJ
authors.lastname: Schaefer
authors.forename: T
authors.initials: T
authors.lastname: Jahnke
authors.forename: S
authors.initials: S
authors.lastname: Müller-Hülsbeck
authors.forename: A M
authors.initials: AM
authors.lastname: Wulff
authors.forename: B
authors.initials: B
authors.lastname: Sattler
authors.forename: M
authors.initials: M
authors.lastname: Schmidt
authors.forename: M
authors.initials: M
authors.lastname: Siggelkow
authors.forename: F K W
authors.initials: FK
authors.lastname: Schaefer
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical; D002983:Clinical Competence; D004630:Emergencies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011859:Radiography; D015642:Radiology, Interventional / Q000379:methods*; D006435:Renal Dialysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D011138:Polytetrafluoroethylene