title: Endovascular treatment of juxta-anastomotic venous stenoses of forearm radiocephalic fistulas: long-term results and prognostic factors.
abstract: OBJECTIVE
  To evaluate long-term results of endovascular procedures in treatment of venous juxta-anastomotic stenoses (JASs) of native forearm radiocephalic arteriovenous fistulas (AVFs) and to identify prognostic factors influencing these results.
  
  
  METHODS
  During a 124-month period, 147 endovascular interventions were performed in 75 forearm radiocephalic AVFs with JASs defined as stenoses located within the first 5 cm of the outflow vein. Prognostic factors included patient characteristics (age, sex, diabetes), AVF-related characteristics (location on forearm, age, maturity), stenosis-related characteristics (position relative to anastomosis, length, and degree), and degree of residual stenosis and delay of restenosis after the first endovascular procedure.
  
  
  RESULTS
  At 1 and 3 years, access primary patency (PP) rates were 46.6% (95% confidence interval [CI], 36.3%-59.9%) and 25.5% (95% CI, 15.7%-41.6%) and assisted PP (APP) rates were 81.3% (95% CI, 72.6%-91.1%) and 63.2% (95% CI, 50.6%-79.0%), respectively. Stenosis degree of 50%-75% (P = .017), stenosis length of 10 mm or more (P = .017), and time before first restenosis of less than 6 months (P = .03) significantly increased the frequency of endovascular procedures during follow-up. However, only the degree of residual stenosis after the first endovascular treatment significantly affected long-term APP (P = .039). When residual stenosis was less than 50%, 1- and 2-year access APP rates were 84.6% (95% CI, 75.8%-94.4%) and 76.1% (95% CI, 64.6%-89.6%), respectively. When it was at least 50%, the respective APP rates were 62.3% (95% CI, 38.9%-99.9%) and 46.8% (95% CI, 22.4%-97.7%).
  
  
  CONCLUSIONS
  Endovascular treatment of JASs in forearm radiocephalic AVFs provides good long-term results except when the residual stenosis after the first procedure is 50% or more. In that case, the optimal treatment remains to be determined.
authors: Department of Urinary and Vascular Radiology, Hospices Civils de Lyon, Hôpital Edouard Herriot, France.
authors: Julie
authors: J
authors: Mortamais
authors: Matthieu
authors: M
authors: Papillard
authors: Nicolas
authors: N
authors: Girouin
authors: Romain
authors: R
authors: Boutier
authors: Laure
authors: L
authors: Cougnaud
authors: Xavier
authors: X
authors: Martin
authors: Lionel
authors: L
authors: Badet
authors: Laurent
authors: L
authors: Juillard
authors: Olivier
authors: O
authors: Rouvière
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D002648:Child; D003251:Constriction, Pathologic; D005260:Female; D005542:Forearm / Q000098:blood supply*; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D017534:Radial Artery / Q000503:physiopathology / Q000601:surgery*; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D055815:Young Adult