title: Use of the Amplatzer Type 2 Plug for Flow Redirection in Failing Autogenous Hemodialysis Fistulae.
abstract: OBJECTIVE
  To present our experience with redirecting the outflow of mature arteriovenous fistulae (AVFs) in patients with cannulation and/or suboptimal flow problems by percutaneous intervention using the Amplatzer Vascular Plug II (AVP II).
  
  
  METHODS
  We retrospectively reviewed patients who presented with difficulty in cannulation and/or suboptimal flow in the puncture zone of the AVF and who underwent intervention using the AVP II to redirect the outflow through a better cannulation zone from March 2009 to November 2012. The mean survival rate of all AVFs was estimated, and the effects of patient age, sex, and AVF age on the AVF survival time were determined.
  
  
  RESULTS
  In total, 31 patients (17 male and 14 female) with a mean age of 57.8 years (range, 20-79 years) were included. In 2 patients, the AVF failed within the first 15 days because of rapid thrombosis. In 9 patients, the new AVF route was working effectively until unsalvageable thrombosis developed. One of the 31 patients died 9 months before the last radiologic evaluation. The new AVF route was still being used for dialysis in the remaining 19 patients. The mean AVF survival rate was 1,061.4 ± 139.4 days (range, 788-1,334 days). Patient age, sex, and AVF age did not affect the survival time.
  
  
  CONCLUSIONS
  We suggest that the AVP II is useful for redirecting the outflow of AVFs with cannulation problems and suboptimal flow. Patency of existing AVFs may be extended, thereby extending surgery-free or catheter intervention-free survival period.
authors.affiliation: Radiology Department, Turgut Ozal University Hospital, Ankara, Turkey, bozkurtalper@yahoo.com.
authors.forename: Alper
authors.initials: A
authors.lastname: Bozkurt
authors.forename: İsmail
authors.initials: İ
authors.lastname: Kırbaş
authors.forename: Benan
authors.initials: B
authors.lastname: Kasapoglu
authors.forename: Mehmet Akif
authors.initials: MA
authors.lastname: Teber
mesh_terms: D000328:Adult; D000368:Aged; D001164:Arteriovenous Fistula / Q000150:complications / Q000628:therapy*; D004867:Equipment Design; D005260:Female; D006083:Graft Occlusion, Vascular / Q000150:complications / Q000628:therapy*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D055989:Septal Occluder Device; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult