title: Outcomes of endovascular intervention for salvage of failing hemodialysis access.
abstract: OBJECTIVE
  To investigate the effectiveness of endovascular balloon angioplasty to preserve the patency of failing hemodialysis arteriovenous fistulas (AVF) and prosthetic arteriovenous grafts (AVG).
  
  
  METHODS
  Patients on hemodialysis who received endovascular intervention for access problems were retrospectively analyzed. Fistulography was performed on patients who were suspected to have access stenosis and balloon angioplasty performed in the same setting if a stenosis of ≥50% is detected. Patients were followed up for post-operative complications and access restenosis or failure.
  
  
  RESULTS
  42 hemodialysis patients with 44 access sites (29 AVFs, 15 AVGs) required endovascular balloon angioplasty. There were no perioperative complications. Technical success rate was 100%. Median time from initial access creation to first balloon angioplasty was 13 months (2-146 months) for AVFs and 8 months (2-71 months) for AVGs. 19 of 44 patients subsequently developed restenosis. Median time for restenosis or access failure was 11 months (1-18 months) for AVFs and 5 months (1-10 months) for AVGs. Kaplan-Meier analysis for access patency after endovascular intervention showed 72% patency at 6 months and 32% at 12 months.
  
  
  CONCLUSIONS
  Endovascular balloon angioplasty is effective in restoring patency of failing hemodialysis accesses. Recurrence is common, and repeat interventions are required.
authors.affiliation: Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, National University Hospital, Singapore.
authors.forename: Terence Lx
authors.initials: TL
authors.lastname: Tan
authors.forename: Kyin K
authors.initials: KK
authors.lastname: May
authors.forename: Peter A
authors.initials: PA
authors.lastname: Robless
authors.forename: Pei
authors.initials: P
authors.lastname: Ho
keywords: angioplasty; arteriovenous fistula; arteriovenous graft; hemodialysis; renal failure
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