title: Comparison of surgical and endovascular salvage procedures for juxta-anastomotic stenosis in autogenous wrist radiocephalic arteriovenous fistula.
abstract: BACKGROUND
  Although dysfunctional radiocephalic arteriovenous fistulas (RCAVFs) are typically treated surgically, the endovascular approach is also considered suitable. The aim of this retrospective study was to compare the cumulative patency rates following surgical and endovascular salvaging of dysfunctional RCAVFs, and to evaluate whether the maturity of vascular access sites at the time of treatment influenced the outcomes.
  
  
  METHODS
  A total of 60 patients underwent surgical or endovascular salvage treatment for juxta-anastomotic stenosis of autogenous wrist RCAVFs: 35 patients underwent proximal neo-anastomosis and 25 underwent percutaneous transluminal angioplasty (PTA).
  
  
  RESULTS
  Clinical and anatomical success rates were, respectively, 100% and 97.1% in the surgery group, and 100% and 96.0% in the angioplasty group (P = 0.81). The post-treatment restenosis rate was higher in the angioplasty group (n = 11, 46.0%) than in the surgery group (n = 8, 22.8%), without reaching statistical significance (P = 0.15). In a Kaplan-Meier analysis, the primary and assisted primary patency rates were significantly higher in the surgery group (P = 0.036 and P = 0.026, respectively), but there was no significant difference in secondary patency rates between the groups (P = 0.52). When stratified by RCAVF maturity at the time of treatment, no significant difference was noted in primary patency rates between the treatment groups. After adjusting for other variables, the relative risk of restenosis was significantly higher in the angioplasty group (hazard ratio 2.56; 95% confidence interval 1.02-6.46; P = 0.046).
  
  
  CONCLUSIONS
  Post-treatment primary and assisted primary patency rates after proximal neo-anastomosis were significantly higher than after PTA, and RCAVF maturity did not influence the outcomes.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
authors.forename: Hyunwook
authors.initials: H
authors.lastname: Kwon
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
authors.forename: Ji Yoon
authors.initials: JY
authors.lastname: Choi
authors.affiliation: Department of Radiology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
authors.forename: Heung Kyu
authors.initials: HK
authors.lastname: Ko
authors.affiliation: Biostatistics Collaboration Unit, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
authors.forename: Min Joo
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Department of Surgery, Chung-Ang University Hospital, Seoul, Korea.
authors.forename: Hyangkyoung
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Surgery, Ulsan University Hospital, Ulsan, Korea.
authors.forename: Hojong
authors.initials: H
authors.lastname: Park
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
authors.forename: Youngjin
authors.initials: Y
authors.lastname: Han
authors.affiliation: Department of Radiology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
authors.forename: Gi-Young
authors.initials: GY
authors.lastname: Ko
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
authors.forename: Tae-Won
authors.initials: TW
authors.lastname: Kwon
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea. Electronic address: ypcho@amc.seoul.kr.
authors.forename: Yong-Pil
authors.initials: YP
authors.lastname: Cho
mesh_terms: D017130:Angioplasty; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D003251:Constriction, Pathologic; D057510:Endovascular Procedures; D005260:Female; D006083:Graft Occlusion, Vascular / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures; D014953:Wrist / Q000098:blood supply*