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Saiki T, Sasaki K, Doi S, Takahashi A, Osaki Y, Ishiuchi N, Maeoka Y, Kawai T, Kawaoka K, Takahashi S, Nagai T, Irifuku T, Nakashima A, Masaki T. Comparison between the 0- and 30-s balloon dilation time in percutaneous transluminal angioplasty for restenosed arteriovenous fistula among hemodialysis patients: a multicenter, prospective, randomized trial (CARP study). Clin Exp Nephrol 2024; 28:647-655. [PMID: 38416340 PMCID: PMC11189949 DOI: 10.1007/s10157-024-02469-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/22/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND This study aims to compare patency rates of the 0- and 30-s (sec) balloon dilation time in hemodialysis (HD) patients with restenosis after percutaneous transluminal angioplasty (PTA). METHODS The patients who underwent PTA within 6 months for failed arteriovenous fistula at the forearm were randomly assigned the 0-s or 30-s dilation time group. Effect of dilation time on the 3- and 6-month patency rates after PTA was examined. RESULTS Fifty patients were enrolled in this study. The 3-month patency rate in the 30-s dilation group was better than that in the 0-s dilation group (P = 0.0050), while the 6-month patency rates did not show a significant difference between the two groups (P = 0.28). Cox's proportional hazard model revealed that 30-s of inflation time (hazard ratio 0.027; P = 0.0072), diameter of the proximal (hazard ratio 0.32; P = 0.031), and dilation pressure (hazard ratio 0.63; P = 0.014) were associated with better 3-month patency. Dilation pressure between previous and present PTA did not differ in the 0-s (P = 0.15) and 30-s dilation groups (P = 0.16). The 6-month patency rate of the present PTA in the 30-s dilation group was higher than that of the previous PTA (P = 0.015). The visual analog scale did not differ between the two groups (P = 0.51). CONCLUSION The presenting data suggest that 30-s dilation potentially results in a better 3-month patency rate than 0-s dilation in HD patients with restenosis after PTA.
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Affiliation(s)
- Tomoki Saiki
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kensuke Sasaki
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Shigehiro Doi
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Akira Takahashi
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yosuke Osaki
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Naoki Ishiuchi
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yujiro Maeoka
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | | | | | - Shunsuke Takahashi
- Department of Nephrology, National Hospital Organization Kure Medical Center, Kure, Japan
| | | | - Taisuke Irifuku
- Department of Nephrology, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Japan
| | - Ayumu Nakashima
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Takao Masaki
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
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Maleux G, van der Linden E, Heijboer RJJ, Serafino GP, Wüst AFJ, Dol JA, Gabriels K, Pattynama P. Multicenter Randomized Controlled Trial of APERTO-Paclitaxel Drug-Eluting Balloon Angioplasty Versus Standard Percutaneous Transluminal Angioplasty in Dysfunctional Hemodialysis Grafts and Native Fistulae. J Endovasc Ther 2023:15266028231215212. [PMID: 38053508 DOI: 10.1177/15266028231215212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
PURPOSE to assess the safety and efficacy of APERTO-Paclitaxel-coated balloon angioplasty versus standard angioplasty for the treatment of dysfunctional hemodialysis shunts and native arteriovenous fistulae. METHODS consecutive patients with dysfunctional dialysis related to underlying efferent vein stenosis were included and randomized 1:1 to either APERTO-paclitaxel drug-coated balloon (study arm) or standard percutaneous transluminal angioplasty (control arm). Primary endpoint is time from treatment until dialysis access dysfunction according to standardized Kidney Disease Outcomes Quality Initiative (KDOQI)-guidelines and assessed by Kaplan-Meier survival curves and tested for significance with log-rank analysis. Secondary endpoints include device, technical, and clinical success of the index angioplasty procedure. RESULTS The study included 103 patients (n=51 study-group) with a de novo (n=33) dysfunctional native arteriovenous fistula (n=79) in the forearm (n=60). The majority of included patients were male with a mean age of 69.8 years, presenting with a dysfunctioning autologous arteriovenous fistula in the forearm. Device-related complications did not occur in any of the included patients. Functional hemodialysis access without need for re-intervention at 1 year after index procedure was found in n=10 (19.6%) and n=5 (9.6%) of patients treated with, respectively, paclitaxel drug-coated balloon and percutaneous transluminal angioplasty (p=0.612). A nonsignificant benefit of paclitaxel drug-coated balloon (n=5; 25%) over percutaneous transluminal angioplasty (n=1; 11%) was found (p=0.953) in de novo lesions in autologous fistulas. CONCLUSION APERTO-paclitaxel drug-coated balloon is a safe balloon catheter to manage dysfunctional hemodialysis access; however, longer period of adequate hemodialysis circuit functioning after endovascular index stenosis treatment, using APERTO-paclitaxel drug-coated balloon versus percutaneous transluminal angioplasty could not be demonstrated. CLINICAL IMPACT APERTO-paclitaxel drug-coated balloon catheter is a safe device to manage dysfunctional hemodialysis access. Compared to conventional angioplasty balloon, the APERTO drug-coated balloon will not result in longer period of adequate hemodialysis circuit functioning. A non-significant benefit of APERTO drug-coated balloon was found in de novo lesions in autologous fistulas.
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Affiliation(s)
| | | | | | | | - Aloys F J Wüst
- Onze Lieve Vrouwe Gasthuis West, Amsterdam, The Netherlands
| | - Johan A Dol
- Medical Center Leeuwarden, Leeuwarden, The Netherlands
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Tseng YH, Wong MY, Kao CC, Lin CC, Lu MS, Lu CH, Huang YK. The role of venous pressure variability during hemodialysis in the prediction of impending arteriovenous graft occlusion. J Vasc Access 2023; 24:895-903. [PMID: 34772292 DOI: 10.1177/11297298211057381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Elevated venous pressure during hemodialysis (VPHD) is associated with arteriovenous graft (AVG) stenosis. This study investigated the role of VPHD variations in the prediction of impending AVG occlusion. METHODS Data were retrieved from 118 operations to treat AVG occlusion (occlusion group) and 149 operations to treat significant AVG stenosis (stenosis group). In addition to analyzing the VPHD values for the three hemodialysis (HD) sessions prior to the intervention, VPHD values were normalized to mean blood pressure (MBP), blood flow rate (BFR), BFR × MBP, and BFR2 × MBP to yield ratios for analysis. The coefficient of variation (CV) was used to measure relative variations. RESULTS The within-group comparisons for both groups revealed no significant differences in the VPHD mean and CV values among the three HD sessions prior to intervention. However, the CVs for VPHD/MBP, VPHD/(BFR × MBP), and VPHD/(BFR2 × MBP) exhibited significant elevation in the occlusion group during the last HD session prior to intervention compared with both the penultimate and antepenultimate within-group HD data (p < 0.05). In the receiver operating characteristic curve analysis, the CV for VPHD/(BFR2 × MBP) was the only parameter able to discriminate between the last and the penultimate HD outcomes (p < 0.001). According to a multivariate analysis, after controlling for covariates, CV for VPHD/(BFR2 × MBP) >8.76% was associated with a higher risk of AVG thrombosis (odds ratio: 3.17, p < 0.001). CONCLUSIONS Increasing the variation in VPHD/(BFR2 × MBP) may increase the probability of AVG occlusion.
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Affiliation(s)
- Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi and Chang Gung University, College of Medicine, Taoyuan
| | - Min Yi Wong
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi and Chang Gung University, College of Medicine, Taoyuan
- Microbiology Research and Treatment Center, Chiayi Chang Gung Memorial Hospital, Puzi City
- Institute of Imaging and Biomedical Photonics, College of Photonics, National Chiao Tung University, Tainan
| | - Chih-Chen Kao
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi and Chang Gung University, College of Medicine, Taoyuan
| | - Chien-Chao Lin
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi and Chang Gung University, College of Medicine, Taoyuan
| | - Ming-Shian Lu
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi and Chang Gung University, College of Medicine, Taoyuan
| | - Chu-Hsueh Lu
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi and Chang Gung University, College of Medicine, Taoyuan
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi and Chang Gung University, College of Medicine, Taoyuan
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Second Percutaneous Transluminal Angioplasty Versus Surgical Reconstruction for Hemodialysis Access Failure Within a Short Time Period. Ann Vasc Surg 2023; 89:147-152. [PMID: 36328349 DOI: 10.1016/j.avsg.2022.09.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/22/2022] [Accepted: 09/21/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The purpose of this study was to compare patency and nonabandonment rates for second percutaneous transluminal angioplasty (PTA) and surgical reconstruction for the treatment of failing vascular access due to restenosis or reocclusion in a short time after initial PTA. METHODS Seventy two consecutive patients who underwent second treatment within 90 days after the initial PTA were evaluated retrospectively. The patency (time to corrective procedure) and access abandonment were compared among patients who underwent a second PTA (n = 35) and those who underwent surgical reconstruction (n = 37). Univariate and multivariate analyses were performed to determine independent predictors of patency and access abandonment at 1 year after the treatment. RESULTS At 1 year after the treatment, the patency rates were 35.1% and 11.4% (P = 0.02) and nonabandonment rates were 64.9% and 77.1% (P = 0.25) for surgical reconstruction and second PTA, respectively. The Kaplan-Meier survival analysis showed that the surgical reconstruction group had better patency probability (P = 0.02), but there was no difference in the nonabandonment probability between the groups (P = 0.29). Shorter time to retreatment was associated with good patency. The female gender was likely to be associated with access abandonment. CONCLUSIONS The access abandonment between the 2 procedures had no difference, although surgical reconstruction provided better patency than second PTA.
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Tan W, Boodagh P, Selvakumar PP, Keyser S. Strategies to counteract adverse remodeling of vascular graft: A 3D view of current graft innovations. Front Bioeng Biotechnol 2023; 10:1097334. [PMID: 36704297 PMCID: PMC9871289 DOI: 10.3389/fbioe.2022.1097334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023] Open
Abstract
Vascular grafts are widely used for vascular surgeries, to bypass a diseased artery or function as a vascular access for hemodialysis. Bioengineered or tissue-engineered vascular grafts have long been envisioned to take the place of bioinert synthetic grafts and even vein grafts under certain clinical circumstances. However, host responses to a graft device induce adverse remodeling, to varied degrees depending on the graft property and host's developmental and health conditions. This in turn leads to invention or failure. Herein, we have mapped out the relationship between the design constraints and outcomes for vascular grafts, by analyzing impairment factors involved in the adverse graft remodeling. Strategies to tackle these impairment factors and counteract adverse healing are then summarized by outlining the research landscape of graft innovations in three dimensions-cell technology, scaffold technology and graft translation. Such a comprehensive view of cell and scaffold technological innovations in the translational context may benefit the future advancements in vascular grafts. From this perspective, we conclude the review with recommendations for future design endeavors.
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Affiliation(s)
- Wei Tan
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, United States,*Correspondence: Wei Tan,
| | - Parnaz Boodagh
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Sean Keyser
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, United States
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Luo Q, Liu H, Yang Q. Analysis of Factors Influencing Restenosis after Percutaneous Transluminal Angioplasty. Blood Purif 2022; 51:1031-1038. [PMID: 35504252 DOI: 10.1159/000524159] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/21/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study aimed to analyse the influencing factors of arteriovenous fistula (AVF) ultrasound-guided restenosis after percutaneous transluminal angioplasty (PTA). METHODS This was a retrospective trial. The clinical data and ultrasound examination data of patients in maintenance haemodialysis who received ultrasound-guided PTA for AVF stenosis at our hospital from January 2018 to December 2020 were retrospectively analysed. The fistula patency and the relationship between age, dialysis age, fistula service age, combined hypertension, diabetes, hypoproteinaemia, stenosis type, fistula location, and patency rate after the operation were evaluated. RESULTS A total of 128 participants were evaluated. The results showed that being over 65 years old, with complications from hypertension, diabetes, and hypoproteinaemia, are all risk factors affecting the patency of postoperative internal fistulas. Compared with lumen stenosis, the patency rate of hyperplastic endothelial stenosis (p = 0.014) and thrombotic stenosis (p = 0.017) was lower, and the difference was statistically significant. The patency rate of the mixed site (p = 0.010), the anastomotic site (p = 0.041), and the cephalic vein near the anastomotic site (p = 0.018) was lower than the forearm cephalic vein, and the difference was statistically significant. CONCLUSION Age, hypertension complications, diabetes complications, hypoproteinaemia, and the type and location of the AVF stenosis were essential for vascular patency of internal fistulas after PTA. Other risk factors of restenosis after PTA still need further research.
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Affiliation(s)
- Qian Luo
- Department of Ultrasonography, Yongchuan Hospital of Chongqing Medical University, Chongqing, China.,Leshan Hospital of Traditional Chinese Medicinel, Leshan, China
| | - Hong Liu
- Department of Radiology, Leshan Hospital of Traditional Chinese Medicine, Leshan, China
| | - Quan Yang
- Department of Radiology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
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Noh SY, Kim YJ, Goo DE, Kwon SH. Salvage of a Radiocephalic Arteriovenous Hemodialysis Fistula by Percutaneous Angioplasty to Increase Retrograde Flow from the Palmar Arch in Patients with an Occluded Radial Artery. J Vasc Interv Radiol 2020; 32:92-98. [PMID: 33153864 DOI: 10.1016/j.jvir.2020.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/18/2020] [Accepted: 09/17/2020] [Indexed: 11/15/2022] Open
Abstract
This brief report presents 12 patients who underwent percutaneous transluminal angioplasty (PTA) to increase the retrograde blood flow from the palmar arch. All the patients had radiocephalic arteriovenous fistulas with occluded feeding arteries. The technical success rate was 100%. Three patients (25.0%) underwent surgical repair for restenosis, 2 patients (16.6%) underwent surgical repair for other reasons, 5 patients (41.8%) underwent repeated PTAs for restenosis, and 2 patients (16.6%) had no further treatment. The target lesion primary patency rates at 6, 12, 36, and 60 months were 90.9%, 54.5%, 36.4%, and 18.2%, respectively.
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Affiliation(s)
- Seung Y Noh
- Department of Radiology, Kyung Hee University Hospital, Seoul, Korea
| | - Yong J Kim
- Department of Radiology, Soon Chun Hyang University Hospital, 59 Daesagwan-Ro, Yongsan-gu, Seoul 04401, Korea.
| | - Dong E Goo
- Department of Radiology, Soon Chun Hyang University Hospital, 59 Daesagwan-Ro, Yongsan-gu, Seoul 04401, Korea
| | - Soon H Kwon
- Department of Internal Medicine, Division of Nephrology, Soon Chun Hyang University Hospital, 59 Daesagwan-Ro, Yongsan-gu, Seoul 04401, Korea
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Zhu ZR, Zou L, Xing Y, Tan YC, Xu GJ, He ZJ, Cao JQ, Wu JY, Liang XX, Zhang HP, Tan YH, Luo CH. Predictors of primary patency after percutaneous balloon angioplasty for stenosis of Brescia-Cimino hemodialysis arteriovenous fistula. Br J Radiol 2020; 93:20190505. [PMID: 32101462 DOI: 10.1259/bjr.20190505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Percutaneous transluminal balloon angioplasty (PTA) is recommended as the first choice to treat stenosis of Brescia-Cimino arteriovenous fistulas (B-C AVFs). The ability to predict which B-C AVFs are at risk for recurrent stenosis post-PTA would allow closer monitoring of patients, and possibly result in surgical intervention rather than repeat PTA. The purpose of this study was to identify predictive factors of primary patency after PTA in B-C AVFs. METHODS Patients diagnosed with B-C AVF primary stenosis and treated by PTA between November 2013 and March 2018 were included in the study. Patient and stenotic lesion characteristics and PTA procedure factors were included in the analysis. The Kaplan-Meier method was used to analyze the primary patency rate. Cox proportional hazard regression analysis was used to identify factors predictive of decreased primary patency. RESULTS 74 patients (35 males, 39 females) with a mean age of 61.68 ± 11.44 years (range, 36-84 years) were included in the study. The mean B-C AVF age was 16.34 ± 12.93 months (range, 2-84 months), and the median primary patency time was 7.79 ± 0.48 months. Cox proportional hazard regression analysis revealed stenosis location at the inflow artery [hazard ratio (HR)=3.83, 95% confidence interval (CI): 1.46-10.09] or anastomosis (HR = 1.90, 95% CI: 1.09-3.32), dilation >2 times during PTA (HR = 2.30, 95% CI: 1.22-4.34), and residual stenosis >30% (HR = 2.42, 95% CI: 1.26-4.63) were significantly associated with decreased patency. CONCLUSION In conclusion, the primary patency rate of PTA for B-C AVF dysfunction is reduced by dilation >2 times, residual stenosis >30%, and stenosis located at the inflow artery or anastomosis. These results may help in tailoring surveillance programs, multiple PTA, or a proximal re-anastomosis surgery in patients with AVF dysfunction. ADVANCES IN KNOWLEDGE A number of studies have been conducted to examine the predictors of primary patency after PTA, however, no definitive conclusions have been reached. Our study revealed that stenosis location at the inflow artery or anastomosis, dilation >2 times during PTA, and residual stenosis >30% were the predictors of primary patency after PTA, which may help in tailoring surveillance programs, multiple PTA, or a proximal re-anastomosis surgery in patients with arteriovenous fistulas dysfunction.
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Affiliation(s)
- Zheng-Rong Zhu
- Division of Vascular Surgery, the First People's Hospital of Foshan, Foshan, China
| | - Lan Zou
- Division of Vascular Surgery, the First People's Hospital of Foshan, Foshan, China
| | - Yue Xing
- Division of Vascular Surgery, the First People's Hospital of Foshan, Foshan, China
| | - Yu-Can Tan
- Division of Vascular Surgery, the First People's Hospital of Foshan, Foshan, China
| | - Guo-Jian Xu
- Division of Vascular Surgery, the First People's Hospital of Foshan, Foshan, China
| | - Zhi-Jian He
- Division of Vascular Surgery, the First People's Hospital of Foshan, Foshan, China
| | - Jian-Qiang Cao
- Division of Vascular Surgery, the First People's Hospital of Foshan, Foshan, China
| | - Jia-Yu Wu
- Division of Vascular Surgery, the First People's Hospital of Foshan, Foshan, China
| | - Xiao-Xia Liang
- Division of Vascular Surgery, the First People's Hospital of Foshan, Foshan, China
| | - Hui-Ping Zhang
- Division of Vascular Surgery, the First People's Hospital of Foshan, Foshan, China
| | - Yan-Hong Tan
- Division of Vascular Surgery, the First People's Hospital of Foshan, Foshan, China
| | - Can-Hua Luo
- Division of Vascular Surgery, the First People's Hospital of Foshan, Foshan, China
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Pawar P, Ayyappan MK, Mathur K, Raju R. Outcomes of endovascular procedures in salvage of arteriovenous fistulas via the transradial route: A prospective study. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.4103/ijves.ijves_76_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Manou-Stathopoulou S, Robinson EJ, Harvey JJ, Karunanithy N, Calder F, Robson MG. Factors associated with outcome after successful radiological intervention in arteriovenous fistulas: A retrospective cohort. J Vasc Access 2019; 20:716-724. [PMID: 31084389 PMCID: PMC6856953 DOI: 10.1177/1129729819845991] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction: Arteriovenous fistulas are the best form of vascular access for
haemodialysis. A radiological balloon angioplasty is the standard treatment
for a clinically relevant stenosis, but the recurrence rate is high. Data on
factors associated with recurrence are limited. Methods: A single centre, retrospective analysis was performed for 124 consecutive
patients who had successful interventions for dysfunctional arteriovenous
fistulae, to examine factors associated with post-intervention patency.
Follow-up was at least 1 year for all patients. Variables associated with
primary and cumulative patency were pre-specified and assessed using both
un-adjusted (univariate) and adjusted Cox proportional hazards models.
Analysis was repeated for a subgroup of 80 patients with a single lesion
only in order to examine the potential effects of stenotic lesion
characteristics on patency. Results: Factors found to have a significant association with poorer outcomes (less
time to loss of patency) included thrombosis at the time of intervention and
a history of previous intervention. Fistula age (log days) was significantly
associated with better outcomes (greater time to loss of patency). Non-white
ethnicity, lesion length, and patient age were also significantly associated
with accelerated loss of patency. Discussion: The factors we have identified as linked to poor outcome may help to identify
patients in whom a balloon angioplasty is unlikely to provide a durable
outcome. This may prompt exploring alternative treatment or dialysis options
at an early stage.
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Affiliation(s)
- Sotiria Manou-Stathopoulou
- Renal, Transplant and Urology Directorate, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Emily J Robinson
- Department of Biostatistics & Health Informatics, King's College London, London, UK
| | - John Julian Harvey
- Department of Interventional Radiology, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Narayan Karunanithy
- Department of Interventional Radiology, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Francis Calder
- Renal, Transplant and Urology Directorate, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Michael G Robson
- Renal, Transplant and Urology Directorate, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Immunology and Microbial Sciences, King's College London, London, UK.,MRC Centre for Transplantation, King's College London, London, UK
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Abstract
To evaluate the outcomes and prognostic factors of endovascular management in immature arteriovenous fistula (AVF) for hemodialysis.From April 2007 to September 2017, 54 patients (male:female = 31:23, mean age 65.63 years, range 33-90 years) who underwent endovascular management for the salvage of immature AVF were retrospectively reviewed. Clinical data, procedural details, and results were evaluated. Primary and secondary patency rates and factors influencing the patency were also analyzed.Technical and clinical success rates were 88.9% (48/54) and 85.2% (46/54), respectively. Mean primary and secondary patency was 42.10 (±8.85) and 91.5 (±14.77) months, respectively. Primary and secondary patency rates were 66% and 89% in 1 year, 66% and 78% in 2 years, and 51% and 78% in 3 years. In multivariate analysis, only brachiocephalic AVF and antegrade access procedures showed significantly shorter primary patency (HR 5.196; 95% CI (1.04-25.77); P = .044, HR 8.096; 95% CI (1.36-48.00); P = .021). There was no statistically significant factor associated with secondary patency in the multivariate study.Endovascular management in immature AVF is safe and effective to make the AVF available. Brachiocephalic AVF and antegrade access procedures are the factors influencing the patency in multivariate analysis.
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Affiliation(s)
- Shin Jae Lee
- Department of Diagnostic Radiology, CHA Bundang Medical Center, College of Medicine, CHA University, Yatap-ro beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do
| | - Gyeong Sik Jeon
- Department of Diagnostic Radiology, CHA Bundang Medical Center, College of Medicine, CHA University, Yatap-ro beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do
| | - Byungmo Lee
- Department of Surgery, Seoul Paik Hospital, College of Medicine, Inje University, Mareunnae-ro, Jung-gu, Seoul, Republic of Korea
| | - Gun Lee
- Department of Thoracic and Cardiovascular Surgery
| | - Jung Jun Lee
- Department of Surgery, CHA Bundang Medical Center, College of Medicine, CHA University, Yatap-ro beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
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12
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Lučev J, Breznik S, Dinevski D, Ekart R, Rupreht M. Endovascular Treatment of Haemodialysis Arteriovenous Fistula with Drug-Coated Balloon Angioplasty: A Single-Centre Study. Cardiovasc Intervent Radiol 2018; 41:882-889. [DOI: 10.1007/s00270-018-1942-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/18/2018] [Indexed: 11/25/2022]
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13
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Wakamoto K, Doi S, Nakashima A, Kawai T, Kyuden Y, Naito T, Asai M, Takahashi S, Murakami M, Masaki T. Comparing the 12-month patency of low- versus high-pressure dilation in failing arteriovenous fistulae: A prospective multicenter trial (YOROI study). J Vasc Access 2018; 19:477-483. [PMID: 29552951 DOI: 10.1177/1129729818760976] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE This study was performed to investigate the effect of the balloon dilation pressure on the 12-month patency rate in patients with failed arteriovenous fistulas undergoing hemodialysis. MATERIALS AND METHODS In this multicenter, prospective, randomized trial, the 4-mm-diameter YOROI balloon was used for dilation of stenotic lesions. The balloons were inflated to a pressure of 8 atm (low-pressure group) or 30 atm to achieve complete expansion (high-pressure group). The 12-month patency rate after balloon angioplasty was analyzed by the Kaplan-Meier method and log-rank test and/or a Cox proportional hazard model. We also investigated the dilation pressure required to achieve complete expansion in the high-pressure group. RESULTS In total, 71 patients were enrolled and allocated to either the low-pressure group (n = 34) or the high-pressure group (n = 37). The 12-month patency rates showed no significant difference between the low- and high-pressure groups (47% and 49%, respectively; p = 0.87). In the low-pressure group, the patency rate was not different between patients with complete dilation and residual stenosis (44% and 50%, respectively; p = 0.87). The Cox proportional hazard model revealed that the 12-month patency rate was associated with the stenosis diameter (hazard ratio 0.36; p = 0.001) and the presence of diabetes (hazard ratio 0.33; p = 0.018). Finally, the pressure required to achieve complete dilation was ≤20 atm in 76% of patients and ≤30 atm in 97% of patients. One patient required a dilation pressure of >30 atm. CONCLUSION The patency rate does not differ between low-pressure dilation and high-pressure dilation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Takao Masaki
- 1 Hiroshima University Hospital, Hiroshima, Japan
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Dariushnia SR, Walker TG, Silberzweig JE, Annamalai G, Krishnamurthy V, Mitchell JW, Swan TL, Wojak JC, Nikolic B, Midia M. Quality Improvement Guidelines for Percutaneous Image-Guided Management of the Thrombosed or Dysfunctional Dialysis Circuit. J Vasc Interv Radiol 2016; 27:1518-30. [DOI: 10.1016/j.jvir.2016.07.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 07/12/2016] [Accepted: 07/14/2016] [Indexed: 01/20/2023] Open
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Mittal V, Srivastava A, Kapoor R, Lal H, Javali T, Sureka S, Patidar N, Arora S, Kumar M. Management of venous hypertension following arteriovenous fistula creation for hemodialysis access. Indian J Urol 2016; 32:141-8. [PMID: 27127358 PMCID: PMC4831504 DOI: 10.4103/0970-1591.174779] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Venous hypertension (VH) is a distressing complication following the creation of arteriovenous fistula (AVF). The aim of management is to relieve edema with preservation of AVF. Extensive edema increases surgical morbidity with the loss of hemodialysis access. We present our experience in management of VH. METHODS A retrospective study was conducted on 37 patients with VH managed between July 2005 to May 2014. Patient demographics, evaluation, and procedures performed were noted. A successful outcome of management with surgical ligation (SL), angioembolization (AE), balloon dilatation (BD) or endovascular stent (EVS) was defined by immediate disappearance of thrill and murmur with resolution of edema in the next 48-72 h, no demonstrable flow during check angiogram and resolution of edema with preservation of AVF respectively. RESULTS All 8 distal AVF had peripheral venous stenosis and were managed with SL in 7 and BD in one patient. In 29 proximal AVF, central and peripheral venous stenosis was present in 16 and 13 patients respectively. SL, AE, BD, and BD with EVS were done in 18, 5, 4, and 3 patients, respectively. All patients had a successful outcome. SL was associated with wound related complications in 11 (29.73 %) patients. A total of 7 AVF were salvaged. One had restenosis after BD and was managed with AE. BD, EVS, and AE had no associated morbidity. CONCLUSIONS Management of central and peripheral venous stenosis with VH should be individualized and in selected cases it seems preferable to secure a new access in another limb and close the native AVF in edematous limb for better overall outcome.
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Affiliation(s)
- Varun Mittal
- Department of Urology and Kidney Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Aneesh Srivastava
- Department of Transplant Surgery and Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rakesh Kapoor
- Department of Urology and Kidney Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Hira Lal
- Department of Radio Diagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Tarun Javali
- Department of Urology and Kidney Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjoy Sureka
- Department of Urology and Kidney Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nitesh Patidar
- Department of Urology and Kidney Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sohrab Arora
- Department of Urology and Kidney Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Manoj Kumar
- Department of Urology and Kidney Transplant, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Risk Factors Associated with Arteriovenous Fistula Failure after First Radiologic Intervention. J Vasc Access 2015; 17:167-74. [DOI: 10.5301/jva.5000459] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2015] [Indexed: 11/20/2022] Open
Abstract
Purpose Improving arteriovenous fistula (AVF) patency is an integral part of the care of hemodialysis patients, often requiring procedures such as percutaneous transluminal angioplasty (PTA). However, these interventions may fail to reduce AVF dysfunction and failure. The purpose of this study was to determine predictive factors for subsequent AVF failure post-PTA. Methods Data from 155 consecutive AVFs in 155 patients at a single institution who had undergone a first PTA and had at least 1 year of follow-up data were analyzed. Using survival analysis, we assessed primary and secondary patency, and identified predictive factors taking into account competing risks. Results Of the 155 patients, 52% required multiple subsequent PTAs; 32% of the AVFs were not in use prior to the first PTA. At first PTA, 83% had outflow vein stenosis (OVS), 26% had multiple stenoses and 43% of stenoses were longer than 2 cm. During follow-up, 1-, 2-, 3-year postintervention primary patency was 41%, 32%, 32% and secondary patency was 80%, 71% and 68%. AVFs with stenoses greater than 2 cm or OVS were at higher risk of requiring multiple PTAs (p = 0.04, 0.006). Factors associated with requiring a second PTA included stenosis greater than 2 cm (hazard ratio (HR) = 1.8, 95% confidence interval (CI) = 1.2-2.9), OVS (HR = 2.5, 95% CI = 1.1-5.4) and primary renal diagnosis of diabetes or renal vascular diseases (HR = 1.8, 95% CI = 1.1-2.9); after adjustments for competing risks, OVS and stenosis length remained associated with requiring subsequent PTAs. Conclusions The location and size of the AVF stenosis at first PTA appear to be consistent factors associated with worse postintervention primary patency.
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Percutaneous Transluminal Angioplasty in Japan: Five-Center Investigation. J Vasc Access 2015; 16 Suppl 10:S38-42. [DOI: 10.5301/jva.5000426] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2015] [Indexed: 11/20/2022] Open
Abstract
Purpose Percutaneous transluminal angioplasty (PTA) is the first-line treatment for vascular access stenosis. To our knowledge, multicenter clinical research of PTA has not been reported in Japan. We examined the efficacy and safety of PTA for arteriovenous fistula (AVF) and arteriovenous graft (AVG) in five centers of Japan. Methods Three hundred cases of angioplasty for AVF and 300 for AVG were examined in three centers each. A hundred consecutive patients from each center who underwent PTA for AVG or AVF prior to March 2014 and met the inclusion criteria were searched retrospectively. Primary patency rates were estimated using the Kaplan-Meier method. Results The mean age was 69.3 ± 11.2 years in the AVF group and 70.2 ± 11.9 years in the AVG group. The anatomical success rates were 51.7% (155 of 300) in the AVF group and 72.0% (216 of 300) in the AVG group. The clinical success rates were 99.7% (299 of 300) in the AVF group and 100% (300 of 300) in the AVG group. A total of 25 complications (4.17%) were encountered in both groups including one major complication (0.17%). The primary patency was 99.0% at 1 month, 87.9% at 3 months and 51.7% at 6 months in the AVF group, and 96.0% at 1 month, 64.8% at 3 months and 20.4% at 6 months in the AVG group. Conclusions The clinical success rate of PTA in five centers was relatively high and a major complication rate was only 0.17%. However, anatomical success rates were low comparing with the previous studies and the primary patency rates were inferior to the past data.
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Factors Associated with Patency Following Angioplasty of Hemodialysis Fistulae. J Vasc Interv Radiol 2014; 25:1419-26. [DOI: 10.1016/j.jvir.2014.05.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/27/2014] [Accepted: 05/28/2014] [Indexed: 11/19/2022] Open
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Neuen BL, Gunnarsson R, Webster AC, Baer RA, Golledge J, Mantha ML. Predictors of patency after balloon angioplasty in hemodialysis fistulas: a systematic review. J Vasc Interv Radiol 2014; 25:917-24. [PMID: 24703320 DOI: 10.1016/j.jvir.2014.02.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 02/08/2014] [Accepted: 02/10/2014] [Indexed: 01/05/2023] Open
Abstract
Percutaneous transluminal angioplasty (PTA) is an established treatment for dysfunctional hemodialysis fistulas. This article systematically reviews evidence for predictors of patency after PTA. Outcomes assessed were primary, assisted primary, and secondary patency after intervention, and findings were summarized descriptively. This review included 11 nonrandomized observational studies of 965 fistulas in 939 patients. Follow-up ranged from 0 days to 10 years. Study quality was overall suboptimal. Newer fistulas and longer lesion length may be associated with primary patency loss after PTA. Further studies are needed to confirm these findings, to identify potentially modifiable factors, and to guide the testing of new endovascular devices.
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Affiliation(s)
- Brendon L Neuen
- School of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia.
| | - Ronny Gunnarsson
- School of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia; Research and Development Unit for Primary Health Care and Dental Care, Southern Älvsborg County, Region Västra Götaland, Sweden; Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Angela C Webster
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Richard A Baer
- Department of Renal Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, James Cook University, Townsville, Queensland, Australia; Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia
| | - Murty L Mantha
- Department of Renal Medicine, Cairns Hospital, Cairns, Queensland, Australia
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Endovascular Salvage of Immature Autogenous Hemodialysis Fistulas. Cardiovasc Intervent Radiol 2014; 37:671-8. [DOI: 10.1007/s00270-014-0856-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 01/16/2014] [Indexed: 10/25/2022]
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Mortamais J, Papillard M, Girouin N, Boutier R, Cougnaud L, Martin X, Badet L, Juillard L, Rouvière O. Endovascular Treatment of Juxta-anastomotic Venous Stenoses of Forearm Radiocephalic Fistulas: Long-term Results and Prognostic Factors. J Vasc Interv Radiol 2013; 24:558-64; quiz 565. [DOI: 10.1016/j.jvir.2012.12.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 12/03/2012] [Accepted: 12/06/2012] [Indexed: 11/30/2022] Open
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Percutaneous transluminal angioplasty for radial-cephalic fistulae with stenosis at the arteriovenous junction. Am J Med Sci 2012; 343:435-9. [PMID: 22052413 DOI: 10.1097/maj.0b013e318231153c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aim of this study was to analyze the predictive factors for initial success and long-term patency of percutaneous transluminal angioplasty for radial-cephalic (RC) fistulae with stenosis at the arteriovenous junction (AVJ). Stenosis at the AVJ of RC fistulae involves both the feeding artery and drainage vein and is similar to a bifurcation lesion, which carries a worse outcome. The optimal intervention method for this type of lesion is currently unknown. METHODS Ninety-one percutaneous transluminal angioplasty procedures for stenosis at the AVJ of RC fistulae were reviewed retrospectively. Parameters including age, sex, location of the RC fistula (right or left arm), approach site (radial artery or cephalic vein) and involvement of proximal radial artery (PRA) dilatation were analyzed for initial procedure success and long-term patency rates. RESULTS The total initial success rate was 94.5%. The existence of total occlusion was recognized as the only factor significantly associated with a high procedural failure rate (39% versus 0%, P < 0.001). For long-term patency rate, the only significant factor was the involvement of PRA dilatation (P = 0.026 by Cox-Mantel and 0.03 by generalized Wilcoxon methods). The 6-month, 1-year and 18-month patency rates were 64%, 45.3% and 20.9%, respectively, for all procedures, and 70.7% versus 57.8%, 56.1% versus 35.6% and 36.6% versus 6.7% for procedures with and without PRA dilatation, respectively. CONCLUSIONS In treating stenosis at the AVJ of RC fistulae, while initial procedural failure occurred mainly in occluded lesions, involvement of PRA dilatation was the only significant predictive factor associated with long-term patency.
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Hollenbeck M, Mickley V, Brunkwall J, Daum H, Haage P, Ranft J, Schindler R, Thon P, Vorwerk D. Gefäßzugang zur Hämodialyse. ACTA ACUST UNITED AC 2009. [DOI: 10.1007/s11560-009-0281-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Endovascular Salvage of Nonmaturing Autogenous Hemodialysis Fistulas: Comparison with Endovascular Therapy of Failing Mature Fistulas. J Vasc Interv Radiol 2008; 19:870-6. [DOI: 10.1016/j.jvir.2008.02.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 02/25/2008] [Accepted: 02/25/2008] [Indexed: 11/22/2022] Open
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Lazarides MK, Georgiadis GS, Antoniou GA, Staramos DN. A meta-analysis of dialysis access outcome in elderly patients. J Vasc Surg 2007; 45:420-426. [PMID: 17264030 DOI: 10.1016/j.jvs.2006.10.035] [Citation(s) in RCA: 204] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Accepted: 10/24/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Many authors report inferior patency rates of distal arteriovenous fistulas in elderly patients and others present contradictory results. A meta-analysis of available evidence was performed to assess (1) whether non-elderly adults have the same risk of forearm arteriovenous fistula failure as elderly patients with end-stage renal disease and (2) whether such a distal access has the same risk of failure as more proximal access procedures or grafts in elderly patients. METHODS A literature search was performed using the MEDLINE and SCOPUS electronic databases. The analysis involved studies that comprised subgroups of elderly patients and compared their outcomes with those of non-elderly adults. Articles comparing patency rates of radial-cephalic and proximal fistulas or grafts in elderly patients were also included. Thirteen relevant studies (all cohort observational studies, 11 retrospective) were identified and included in the final analysis. RESULTS The meta-analysis revealed a statistically significantly higher rate of radial-cephalic arteriovenous fistula failure in elderly patients compared with non-elderly adults at 12 (odds ratio [OR], 1.525; P = .001) and 24 months (OR, 1.357, P = .019). The primary radial-cephalic arteriovenous fistula failure rate was also in favor of the non-elderly adults (OR, 1.79; P = .012). Secondary analysis revealed a pooled effect in favor of the elbow brachiocephalic fistulas that was statistically significant (P = .004) compared with distal fistulas in elderly patients. CONCLUSION This meta-analysis found an increased risk of radial-cephalic fistula failure in elderly patients and significant benefit from the creation of proximal autologous brachiocephalic fistulas. If confirmed by further prospective studies, these differences should be considered when planning a vascular access in incident elderly patients.
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Affiliation(s)
- Miltos K Lazarides
- Department of Vascular Surgery, Demokritos University Hospital, Alexandroupolis, Greece.
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Tessitore N, Mansueto G, Lipari G, Bedogna V, Tardivo S, Baggio E, Cenzi D, Carbognin G, Poli A, Lupo A. Endovascular versus Surgical Preemptive Repair of Forearm Arteriovenous Fistula Juxta-Anastomotic Stenosis: Analysis of Data Collected Prospectively from 1999 to 2004. Clin J Am Soc Nephrol 2006; 1:448-54. [PMID: 17699244 DOI: 10.2215/cjn.01351005] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Surgery is the traditional treatment for juxta-anastomotic stenoses in forearm arteriovenous fistulas (AVF), but percutaneous transluminal angioplasty (PTA) is a suitable alternative. No prospective comparative trials between the two have been reported to date, however. A retrospective analysis of prospectively, concurrently collected data was performed to compare the outcome and cost of surgery and PTA in the preemptive repair of juxta-anastomotic stenosis in lower forearm AVF. Sixty-four AVF with >50% venous juxta-anastomotic stenosis were considered: 21 were treated surgically (11 proximal neo-anastomosis and 10 polytetrafluoroethylene interposition graft) and 43 by PTA. After treatment, AVF were monitored by quarterly ultrasound dilution access blood flow measurement. End points were restenosis and procedure failure rate (re-intervention by another technique or access loss), and determinants were analyzed using Cox hazard model. Initial procedural success was 100% for surgery and 95% for PTA (P = 0.539). Restenosis rate was 0.168 and 0.519 events/AVF-year for surgery and PTA, respectively (P = 0.009). The type of procedure was the only variable that was significantly associated with restenosis, the adjusted relative risk being 2.77-fold higher (95% confidence interval 1.07 to 7.17; P = 0.036) after PTA than surgery. The procedure failure rate was 0.110 and 0.097 events/AVF-year for surgery and PTA, respectively (P = 0.736). The cost profile also was similar for the two procedures. This prospective comparative study confirms a higher restenosis rate after PTA than surgery, but with strict surveillance for restenosis, the two procedures show similar assisted primary patency and cost, suggesting that they should be considered equally valid, complementary alternatives in the preemptive treatment of juxta-anastomotic stenosis in forearm AVF.
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Maeda K, Furukawa A, Yamasaki M, Murata K. Percutaneous transluminal angioplasty for Brescia-Cimino hemodialysis fistula dysfunction: technical success rate, patency rate and factors that influence the results. Eur J Radiol 2005; 54:426-30. [PMID: 15899346 DOI: 10.1016/j.ejrad.2004.07.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2004] [Revised: 07/14/2004] [Accepted: 07/19/2004] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the initial clinical success and long-term patency rates of percutaneous transluminal angioplasty (PTA) using a venous approach for dysfunctional Brescia-Cimino fistula and to identify factors that may affect initial success and long-term patency. MATERIALS AND METHODS A total of 99 PTA procedures were performed in retrograde fassion for 60 mature Brescia-Cimino shunts with dysfunction caused by anastomotic or peripheral outflow vein stenosis or occlusion. The initial clinical success rates were compared between stenosis and occlusion using Fisher's exact test. The Kaplan-Meier method was used to calculate the primary and secondary cumulative patency rates, and the log-rank test was used for comparison. Relative risks of patency loss according to clinical characteristics were determined with multivariate Cox models. RESULTS The initial clinical success rate of all interventions was 92%, and the rates for stenosis and occlusion were 99 and 65%, respectively (P < 0.0001). The primary and secondary cumulative patency rates for fistulas (excluding initial failure) at 12 months were 53 and 84%, respectively. The relative risks were 5.2 (P = 0.004) for longer lesions and 4.5 (P = 0.007) for younger fistulas. The primary cumulative patency rate of four patients with a younger fistula and a longer stenosis at 4 months was 0%. CONCLUSION Favorable primary and secondary cumulative patency rates are obtained in most patients. Long lesion length and younger age of fistulas were the two factors that reduced the patency rate after PTA.
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Affiliation(s)
- Kiyosumi Maeda
- Department of Radiology, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu-city, Shiga 520-2192, Japan.
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Singer-Jordan J, Papura S. Cutting Balloon Angioplasty for Primary Treatment of Hemodialysis Fistula Venous Stenoses: Preliminary Results. J Vasc Interv Radiol 2005; 16:25-9. [PMID: 15640405 DOI: 10.1097/01.rvi.0000144868.50440.8a] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess the efficacy of the cutting balloon as the primary tool in percutaneous transluminal angioplasty of hemodialysis access stenoses. MATERIALS AND METHODS A prospective study of symptomatic patients with stenoses of 50% or more in their hemodialysis accesses was undertaken. Provided that no contraindication to the use of cutting balloons existed, the stenoses were treated with the cutting balloon with use of a maximum of a 1:1.1 ratio between expected vessel diameter and balloon diameter. In cases in which dilation to the full diameter of the cutting balloon left a greater than 30% residual stenosis, postprocedural dilation with conventional balloons was carried out. Patient access function was followed. Twenty-nine patients with 42 stenoses have now reached 6 months of follow-up after cutting balloon angioplasty. RESULTS Technical and clinical success rates were 100%. Slight local extravasation occurred in three cases: two had continued pain after the balloon was deflated and were therefore treated with balloon compression with resolution of symptoms and angiographic findings. In two cases, elastic recoil required stent placement to correct the stenosis. At 6 months, 22 patients (76%) remain in the primary patency category. Inclusion of those with primary assisted patency yields 26 patients (90%), and an additional patient had secondary patency, for a total of 93%. Two patients died of causes not directly related to dialysis. CONCLUSION The high degree of technical and clinical success likely reflects the lack of major complications. The 6-month follow-up results match those of other series. Further follow-up will show whether this technique produces better results over the long term.
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Affiliation(s)
- Jonathan Singer-Jordan
- Division of Angiography, Department of Radiology, Western Galilee Hospital, P.O. Box 21, Nahariya, Israel.
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Beathard GA, Litchfield T. Effectiveness and safety of dialysis vascular access procedures performed by interventional nephrologists. Kidney Int 2004; 66:1622-32. [PMID: 15458459 DOI: 10.1111/j.1523-1755.2004.00928.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The purpose of this report was to analyze the results obtained from a group of interventional nephrologists working in multiple centers performing basic procedures that are used routinely in the management of vascular access problems, with an effort toward establishing standards for evaluating success, complication rates, and acceptable times for procedure duration and fluoroscopy. METHODS Data on six basic procedures were analyzed-angioplasty of arteriovenous fistulas (AVF-PTA), angioplasty of synthetic grafts (graft-PTA), thrombectomy of arteriovenous fistulas (AVF declot), thrombectomy of synthetic grafts (graft declot), placement of tunneled dialysis catheters (TDC placement), and tunneled dialysis catheter exchange (TDC exchange). These data were examined both as a group and by individual physician operator. RESULTS. A total of 14,067 cases were performed under the six categories of procedure that were the subject of this report; 13,503 cases (96.18%) were successful. The overall complication rate for the combined group of procedures was 3.54%, with 3.26% falling within the minor category and 0.28% within the major. The number of cases performed in each individual category with success rates for each were as follows: TDC placement-1765 cases, 98.24% successful; TDC exchange-2262 cases, 98.36% successful, AVF-PTA-1561 cases, 96.58% successful; graft-PTA-3560 cases, 98.06% successful; AVF declot-228 cases, 78.10% successful; graft declot-4671 cases, 93.08% successful. CONCLUSION This study demonstrates that appropriately trained interventional nephrologists can perform these basic procedures in both a safe and effective manner.
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