title: Endovascular salvage of immature autogenous hemodialysis fistulas.
abstract: OBJECTIVE
  To report the technical success and long-term clinical outcomes of immature arteriovenous fistula (AVF) after percutaneous angioplasty (PTA).
  
  
  METHODS
  Patients with 58 immature AVF underwent PTA treatment in our institute during the past 9 years. Based on pretreatment ultrasound findings, the immature AVFs were categorized as stenosed, thrombosed, and obliterated type. An optimal entry site was punctured under ultrasound guidance followed by conventional fluoroscopy-guided PTA technique. Technical and clinical success as well as complications were recorded. Patency after angioplasty was estimated using Kaplan-Meier analysis. Predictors of patency were estimated using log-rank test.
  
  
  RESULTS
  In our series, 50 % (29 of 58), 20.7 % (12 of 58), and 29.3 % (17 of 58) of immature AVF were stenosed, thrombosed, and obliterated, respectively. Technical and clinical success was achieved in 96.6 % (56 of 58) of cases with 100 % success in both the stenosed and thrombosed lesions and 88.2 % (15 of 17) success in the obliterated lesions. Vascular ruptures occurred in 12.1 % (7 of 58) of lesions. The overall primary and secondary patency rates of the 58 lesions were 45.4 and 84.2 % at 12 months and 36.5 and 80.1 % at 36 months. There were no significant differences of patency between the three types of lesions (p = 0.075 and 0.093) and the two groups of patients with or without residual side branches after intervention (p = 0.527 and 0.644). There was a significant difference of primary patency in patients with vascular rupture (p = 0.012) with a hazard ratio of 3.236.
  
  
  CONCLUSIONS
  PTA could effectively prolong the lifetime of immature AVFs with high technical success. Vessel rupture was predictive of shorter primary patency, and long-term secondary patency was acceptable.
authors: Department of Radiology, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Rd., Kaohsiung, 81362, Taiwan, ROC, hlliang@vghks.gov.tw.
authors: Huei-Lung
authors: HL
authors: Liang
authors: Jui-Hsun
authors: JH
authors: Fu
authors: Po-Chin
authors: PC
authors: Wang
authors: Matt Chiung-Yu
authors: MC
authors: Chen
authors: Chun-Chieh
authors: CC
authors: Wang
authors: Yih-Huie
authors: YH
authors: Lin
authors: Huay-Ben
authors: HB
authors: Pan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical; D057510:Endovascular Procedures; D005260:Female; D005471:Fluoroscopy; D005542:Forearm; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011677:Punctures; D015641:Radiography, Interventional; D006435:Renal Dialysis; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome; D014463:Ultrasonography