title: Postintervention Patency Rates and Predictors of Patency after Percutaneous Interventions on Intragraft Stenoses within Failing Prosthetic Arteriovenous Grafts.
abstract: OBJECTIVE
  To determine postintervention patency rates after endovascular interventions on intragraft stenosis within failing prosthetic arteriovenous (AV) grafts, as well as predictors of patency.
  
  
  METHODS
  Retrospective review of percutaneous interventions on prosthetic AV grafts presenting with first-time intragraft stenoses over a 7-year period revealed 183 patients (81 male; mean age, 59.7 y). "Intragraft" was defined as 2 cm or more from the arterial or venous anastomosis. Procedural imaging was retrospectively reviewed. Patency rates were estimated by Kaplan-Meier test. Predictors of patency were calculated by Cox proportional-hazards model.
  
  
  RESULTS
  Two-hundred twenty-nine intragraft stenoses were identified in 183 grafts. Intragraft stenoses were treated at a median of 20.7 months (interquartile range, 12.0-33.9 mo) after graft creation. Graft thrombosis was present in 62%. The anatomic success rate of angioplasty was 85%. Fifteen percent required stent or stent-graft deployment because of inadequate response to angioplasty. A concurrent nonintragraft stenosis within the access circuit was identified in 76% of grafts. At 3, 6, and 12 months, postintervention primary patency rates were 56%, 40%, and 23%, respectively. Secondary patency rates were 84%, 77%, and 67%, respectively. The lesion-specific patency rates were 89, 75%, and 63%, respectively. Graft thrombosis (hazard ratio [HR], 1.43; P = .048) and concurrent nonintragraft lesion (HR, 1.51; P = .047) were independent negative predictors of primary patency. Graft thrombosis (HR, 1.81; P = .029) was a negative predictor of lesion patency, and stent or stent-graft deployment (HR, 0.42; P = .045) was a positive predictor of lesion patency.
  
  
  CONCLUSIONS
  Endovascular interventions on intragraft stenoses resulted in primary, secondary, and lesion-specific patency rates of 40%, 77%, and 75%, respectively, at 6 months. Stent or stent-graft deployment may prolong lesion patency.
authors.affiliation: Division of Vascular and Interventional Radiology, Duke University Medical Center, Box 3808, 2311 Erwin Rd., Durham, NC 27710.
authors.forename: Andre B
authors.initials: AB
authors.lastname: Bautista
authors.affiliation: Division of Vascular and Interventional Radiology, Duke University Medical Center, Box 3808, 2311 Erwin Rd., Durham, NC 27710.
authors.forename: Paul V
authors.initials: PV
authors.lastname: Suhocki
authors.affiliation: Division of Vascular and Interventional Radiology, Duke University Medical Center, Box 3808, 2311 Erwin Rd., Durham, NC 27710.
authors.forename: Waleska M
authors.initials: WM
authors.lastname: Pabon-Ramos
authors.affiliation: Division of Vascular and Interventional Radiology, Duke University Medical Center, Box 3808, 2311 Erwin Rd., Durham, NC 27710.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Miller
authors.affiliation: Division of Vascular and Interventional Radiology, Duke University Medical Center, Box 3808, 2311 Erwin Rd., Durham, NC 27710.
authors.forename: Tony P
authors.initials: TP
authors.lastname: Smith
authors.affiliation: Division of Vascular and Interventional Radiology, Duke University Medical Center, Box 3808, 2311 Erwin Rd., Durham, NC 27710. Electronic address: charles.kim@duke.edu.
authors.forename: Charles Y
authors.initials: CY
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000706:statistics & numerical data*; D015984:Causality; D015897:Comorbidity; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D006084:Graft Rejection / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D011379:Prognosis; D011475:Prosthesis Failure; D011859:Radiography; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016896:Treatment Outcome; D014654:Vascular Patency