title: Ultrasound-guided angioplasty for treatment of peripheral stenosis of arteriovenous fistula - a single-center experience.
abstract: OBJECTIVE
  In patients with end-stage renal disease, arteriovenous fistulas (AVFs) are the access of choice for hemodialysis but are often complicated by stenosis. We present single-center experience of 78 ultrasound-guided angioplasty procedures for treating peripheral stenoses of AVFs.
  
  
  METHODS
  Between January 2013 and November 2015, 78 angioplasties were performed under ultrasound guidance in 53 patients with end-stage renal disease who were referred from dialysis centers with low flow rate, difficult cannulation, increased cannulation site bleeding, immature or thrombosed AVF. Angioplasties were carried out in the presence of a structural lesion in the AVF resulting in at least 50% reduction in vein diameter with a blood flow of &lt;250 mL/min or a peak systolic velocity &gt;300 cm/s. Clinical success, anatomical success and post-intervention primary and secondary patency rates at 6, 12, 18 and 24 months were studied.
  
  
  RESULTS
  In 49/53 patients (92.4%), 74 angioplasty procedures were successfully performed, whereas 4/53 patients (7.6%) had primary failure. A total of 35/49 patients (71.4%) underwent single angioplasty procedure whereas 14/49 patients (28.6%) underwent multiple angioplasty procedures. Post-intervention primary patency rates at 6, 12, 18 and 24 months were 78.6%, 60.2%, 53.8% and 48.9%, respectively. Post-intervention secondary patency rates at 6, 12, 18 and 24 months were 100%, 100%, 95.4% and 89%, respectively. Clinical success and anatomical success was 94.8% and 89.7%, respectively.
  
  
  CONCLUSIONS
  Ultrasound-guided angioplasty is an effective method with good long-term outcomes in selected dialysis patients with peripheral stenosis of AVF.
authors.affiliation: Department of Renal Transplant Surgery, Post-Graduate Institute of Medical Education and Research, Chandigarh - India.
authors.forename: Sunil
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Renal Transplant Surgery, Post-Graduate Institute of Medical Education and Research, Chandigarh - India.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Mahajan
authors.affiliation: Department of Renal Transplant Surgery, Post-Graduate Institute of Medical Education and Research, Chandigarh - India.
authors.forename: Shivakumar S
authors.initials: SS
authors.lastname: Patil
authors.affiliation: Department of Renal Transplant Surgery, Post-Graduate Institute of Medical Education and Research, Chandigarh - India.
authors.forename: Navdeep
authors.initials: N
authors.lastname: Singh
authors.affiliation: Department of Renal Transplant Surgery, Post-Graduate Institute of Medical Education and Research, Chandigarh - India.
authors.forename: Soham
authors.initials: S
authors.lastname: Dasgupta
authors.affiliation: Department of Renal Transplant Surgery, Post-Graduate Institute of Medical Education and Research, Chandigarh - India.
authors.forename: Seetharam
authors.initials: S
authors.lastname: Tejavath
authors.affiliation: Department of Renal Transplant Surgery, Post-Graduate Institute of Medical Education and Research, Chandigarh - India.
authors.forename: Sarbpreet
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Renal Transplant Surgery, Post-Graduate Institute of Medical Education and Research, Chandigarh - India.
authors.forename: Deepesh B
authors.initials: DB
authors.lastname: Kenwar
authors.affiliation: Department of Renal Transplant Surgery, Post-Graduate Institute of Medical Education and Research, Chandigarh - India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Department of Renal Transplant Surgery, Post-Graduate Institute of Medical Education and Research, Chandigarh - India.
authors.forename: Mukut
authors.initials: M
authors.lastname: Minz
mesh_terms: D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001783:Blood Flow Velocity; D003251:Constriction, Pathologic; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007194:India; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D006435:Renal Dialysis; D019233:Retreatment; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014654:Vascular Patency