Transjugular venous approach for endovascular intervention in upper-extremity dialysis access fistulae and grafts

Transjugular approach: comparison with conventional endovascular treatment of native arteriovenous fistulas

OBJECTIVES

The aim of this study was to compare the outcomes of the transjugular approach with those of the conventional approach for endovascular treatment of arteriovenous fistulas (AVFs).

METHODS

Between May 2015 and July 2019, 112 patients with endovascular treatment of dysfunctional or immature AVFs were included and divided into the transjugular (n = 46) and conventional (n = 66) groups. Electronic medical records and angiography of the patients were retrospectively reviewed to assess technical and clinical success rates, time to first fistulography, total procedure time, primary and secondary patency, and complications in both groups.

RESULTS

There were no significant differences in technical success rate (87.0% vs 97.0%; P = .062), clinical success rate (80.4% vs 90.9%; P = .109), or total procedure time (60.2 vs 57.9 min; P = .670) between the groups. Cox proportional hazards models showed that the cumulative primary patency was significantly higher in the transjugular group than in the conventional group (P = .041; 6-month patency rates, 93.8% vs 91.5%). Also, a statistically significant difference was found between the cumulative secondary patency of the groups (P = .014; 6-month patency rates, 91.4% vs 86.5%). No major complications were observed.

CONCLUSIONS

Transjugular endovascular treatment of AVFs was successful and effective. Longer patency periods were observed when treated via transjugular access.

ADVANCES IN KNOWLEDGE

This article compared the outcomes of transjugular approaches with those of conventional approaches in the endovascular treatment of native AVFs and showed higher patency periods/rates in the transjugular group than in the conventional group.

Transfemoral Venous Access Facilitates Upper Extremity Dialysis Interventions: Procedural Success and Clinical Outcomes

PURPOSE

To report technical success and clinical outcomes of transfemoral venous access for upper extremity dialysis interventions.

MATERIALS AND METHODS

A total of 15 patients underwent a transfemoral venous approach for fistulography (n = 4; 27%) or thrombectomy (n = 11; 73%) over a 14-month period. Access characteristics, sheath size, thrombectomy method, angioplasty site, fluoroscopy time, radiation dose, technical and clinical success, complications, and post-intervention primary and secondary patency rates were recorded.

RESULTS

Access type included arteriovenous fistulas (n = 10; 67%) and grafts (n = 5; 33%). The most common configuration was brachio-brachial (n = 6; 38%). Mean age of access was 37 months. Mean prior interventions were 4. Right CFV access was used in all patients using 6-8-French (most common: 7-French [n = 10; 67%]) sheaths. Most thrombectomies (n = 11; 73%) required both pharmacologic and mechanical maceration (n = 9; 82%). All accesses required angioplasty to treat underlying stenosis at the outflow vein (n = 12; 80%) or arteriovenous anastomosis (n = 9; 90%). Mean fluoroscopy time was 26.43 min. Air kerma and dose area product were 178.06 ± 225.77 mGy and 57,768.83 ± 87,553.29 μGym², respectively. Procedural and clinical success rates were 93% and 80%, respectively. Technical failure was due to persistent stenosis in one patient. Clinical failure was due to unsuccessful dialysis immediately following intervention in three patients. Mean post-intervention primary patency and secondary patency durations were 2.8 and 4.8 months, respectively. Primary patency rates at 1 and 3 months were 50% and 35%, respectively. Secondary patency rates at 1 and 3 months were 58% and 30%, respectively.

CONCLUSION

A transfemoral venous approach for intervention of upper extremity dialysis accesses may be a valuable adjunct to traditional approaches.