title: Long-Term Patency of Arteriovenous Fistulae Salvaged by Balloon Angioplasty with and without Accessory Vein Embolization: A Retrospective Study.
abstract: OBJECTIVE
  To investigate whether accessory vein embolization (AVE) improves long-term performance of salvaged nonmaturing arteriovenous fistulae (AVFs).
  
  
  METHODS
  This retrospective review included 72 patients who underwent percutaneous balloon angioplasty for salvage of nonmaturing AVFs between 2008 and 2014. AVE was performed on 32 patients between 2008 and 2011 (mean age, 59 y [range, 33-85 y]; men, n = 21; women, n = 11; upper arm, n = 17; forearm, n = 15), whereas the procedure was not performed on 40 patients after 2011 (mean age, 62 y [range, 28-85 y]; men, n = 26; women, n = 14; upper arm, n = 26; forearm, n = 14). Endpoints compared between groups included number of procedures required to achieve maturation, time to maturation, number of procedures required to maintain patency, and duration of primary and secondary patency after intervention.
  
  
  RESULTS
  There was no statistically significant difference in number of procedures to achieve maturation (2.1 ± 1.4 vs 2.4 ± 1.2; P = .24) or time to maturation (26.1 d ± 56.2 vs 41.1 d ± 54.6; P = .072) between AVE and no embolization groups. Primary (P = .21) and secondary patency (P = .14) after intervention were not significantly different between groups. The number of procedures performed to maintain patency after maturation was significantly greater in the AVE group for patients with forearm AVFs (0.11 ± 0.098 vs 0.04 ± 0.064 per patient year; P = .039) but not for patients with upper arm AVFs.
  
  
  CONCLUSIONS
  AVE of AVFs after balloon angioplasty does not lead to significantly improved long-term outcomes. Percutaneous salvage of nonmaturing AVFs in the forearm without AVE resulted in a decreased number of interventions to maintain patency.
authors.affiliation: Division of Vascular Interventional Imaging, Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642.
authors.forename: Ayman
authors.initials: A
authors.lastname: Sawas
authors.affiliation: Division of Vascular Interventional Imaging, Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Baran
authors.affiliation: Division of Vascular Interventional Imaging, Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Foster
authors.affiliation: Division of Vascular Interventional Imaging, Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642.
authors.forename: Joseph
authors.initials: J
authors.lastname: Reis
authors.affiliation: Division of Vascular Interventional Imaging, Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Wing
authors.affiliation: Division of Vascular Interventional Imaging, Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642.
authors.forename: Randeep
authors.initials: R
authors.lastname: Kashyap
authors.affiliation: Division of Vascular Interventional Imaging, Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642.
authors.forename: David
authors.initials: D
authors.lastname: Brhel
authors.affiliation: Division of Vascular Interventional Imaging, Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642. Electronic address: talia_sasson@urmc.rochester.edu.
authors.forename: Talia
authors.initials: T
authors.lastname: Sasson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D001166:Arteriovenous Shunt, Surgical / Q000534:rehabilitation*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014654:Vascular Patency