title: Percutaneous interventions in failing "necklace" hemodialysis grafts: long-term outcomes.
abstract: OBJECTIVE
  To determine primary and secondary patency after percutaneous interventions for malfunctioning anterior chest wall ("necklace") arteriovenous grafts (AVGs) for hemodialysis.
  
  
  METHODS
  Records of six consecutive patients with subclavian artery-to-contralateral subclavian vein necklace AVGs were reviewed. Patients underwent 34 procedures, including 28 balloon angioplasties, 24 pharmacomechanical thrombolyses, and six stent placements. Patency intervals after graft placement and after first intervention were calculated.
  
  
  RESULTS
  After 3 months, primary and secondary patency rates were 33% (two of six grafts) and 67% (four of six grafts), respectively. At 12 months, primary and secondary patency rates were 17% (one of six grafts) and 50% (three of six grafts), respectively. Median and mean primary patency times were 49 and 374 days, and median and mean secondary patency times were 293 and 575 days, respectively. The anatomic success rate of percutaneous interventions in malfunctioning AVGs was 97% (33 of 34 cases). At 3 years after implantation, the graft patency rate was 57% (four of seven grafts).
  
  
  CONCLUSIONS
  Percutaneous interventions were effective at maintaining patency in failing necklace AVGs. However, their primary and secondary patency were inferior to those cited in extremity AVG guidelines set forth by the Society of Interventional Radiology.
authors.affiliation: Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., Room M-361, San Francisco, CA 94143.
authors.forename: Adi J
authors.initials: AJ
authors.lastname: Price
authors.affiliation: Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., Room M-361, San Francisco, CA 94143. Electronic address: nicholas.fidelman@ucsf.edu.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Fidelman
authors.affiliation: Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., Room M-361, San Francisco, CA 94143.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Wilson
authors.affiliation: Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., Room M-361, San Francisco, CA 94143.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Kerlan
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013348:Subclavian Artery / Q000503:physiopathology / Q000601:surgery*; D013350:Subclavian Vein / Q000503:physiopathology / Q000601:surgery*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: AVF; AVG; PTFE; arteriovenous fistula; arteriovenous graft; polytetrafluoroethylene