title: Primary intraoperative transluminal angioplasty: a new approach to reduce the early failure of distal arteriovenous fistulas.
abstract: OBJECTIVE
  About 8 years ago, we approached an intraoperative transluminal angioplasty (ITA) performed during the arteriovenous fistula (AVF) creation, to treat arterial or venous stenosis diagnosed by a preliminary ultrasound examination. Objective of this study is to validate the efficacy of ITA.
  
  
  METHODS
  Early failure (EF) and failure to mature (FTM) were evaluated in 69 AVFs with ITA created in 58 patients in the last 3 years. In the same period, 160 patients received 188 AVFs without ITA and were considered control group. Of the two groups, age, comorbid factors, sex, primary and secondary patency rate (PR) were also analysed.
  
  
  RESULTS
  The two groups were homogeneous for gender and age (70.4 + 11.1 years of ITA group vs. 66.3 + 14.4, p = 0.059). The incidence of diabetes, heart disease and peripheral artery disease was higher in the ITA group (43% vs. 17%, p<0.0001, 35% vs. 6%, p<0.0001 and 56% vs. 15%, p<0.0001, respectively). EF and FTM occurred in seven and eight cases in the ITA group and in 15 and 13 cases in the controls, respectively. Total failure occurred in 24% of ITA group and 14% of the controls (p = 0.2). The primary PR at 6, 12 and 24 months was 78%, 72% and 59% for ITA group and 85%, 78% and 78 % for control group (p<0.01). The secondary PR at 6, 12 and 24 months was 91%, 86% and 80% for ITA group and 95%, 95% and 92% for the controls (p<0.01).
  
  
  CONCLUSIONS
  Our ITA approach has allowed satisfactory results in patients at a high risk of AVF failure.
authors.affiliation: Nephrology and Dialysis Unit, S. Caterina Novella Hospital, Galatina - Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Napoli
authors.forename: Maria L
authors.initials: ML
authors.lastname: Lefons
authors.forename: Domenico
authors.initials: D
authors.lastname: Mangione
authors.forename: Cosimo
authors.initials: C
authors.lastname: Montagna
authors.forename: Elio
authors.initials: E
authors.lastname: Montagna
authors.forename: Anna M
authors.initials: AM
authors.lastname: Montinaro
authors.forename: Caterina
authors.initials: C
authors.lastname: Pati
authors.forename: Giovanni
authors.initials: G
authors.lastname: Sandri
authors.forename: Efisio
authors.initials: E
authors.lastname: Sozzo
authors.forename: Salvatore
authors.initials: S
authors.lastname: Stefanizzi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D015897:Comorbidity; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency