Outcomes of percutaneous interventions in transposed hemodialysis fistulas compared with nontransposed fistulas and grafts.

Abstract

PURPOSE:

To compare postpercutaneous intervention outcomes of autogenous venous-transposition arteriovenous fistulas (AVFs) versus those of autogenous nontransposed AVFs (nAVFs) and prosthetic arteriovenous grafts (AVGs).

MATERIALS AND METHODS:

A total of 591 hemodialysis accesses (195 transposed AVFs [tAVFs], 205 nAVFs, 191 AVGs) in 522 patients (278 male; mean age, 57 y; range, 15–91 y) underwent percutaneous transluminal angioplasty (PTA) and/or mechanical thrombectomy (ie, declotting). Access characteristics, surgical history, percutaneous interventions, postinterventional primary and secondary access patency, and follow-up data were collected. Cox proportional-hazards regression analyses, Fisher exact tests, and χ2 tests were performed.

RESULTS:

Mean follow-up period was 32 months. Mean access ages at initial percutaneous intervention were 260 days (tAVF), 206 days (nAVF), and 176 days (AVG; P < .01). One-year postinterventional primary patency (PIPP) rates were 25% (tAVF), 24% (nAVF), and 14% (AVG). One-year postinterventional secondary patency (PISP) rates were 77% (tAVF), 61% (nAVF), and 63% (AVG). Median PIPP durations were 138 days (tAVF), 121 days (nAVF), and 79 days (AVG; P = .0001). Median PISP durations were 1,076 days (tAVF), 783 days (nAVF), and 750 days (AVG; P = .019). Total interventions needed to maintain PISP were 2.4 (tAVF), 1.3 (nAVF), and 3.2 (AVG) per patient-year (P < .001), which included 1.9, 1.2, and 1.4 PTAs (P < .01) and 0.45, 0.15, and 1.8 declotting procedures, respectively (P < .001).

CONCLUSIONS:

Based on the number of percutaneous interventions needed to maintain PISP, these results confirm the current Dialysis Outcomes Quality Initiative access preference of nAVFs before tAVFs before AVGs. tAVFs offered superior postinterventional outcomes than AVGs. With additional interventions, tAVFs could even outperform nAVFs in terms of PISP.

• Authors: Yan Yan, Timothy W I Clark, Jeffrey I Mondschein, Richard D Shlansky-Goldberg, Mandeep S Dagli, Michael C Soulen, S William Stavropoulos, Deepak Sudheendra, Mark P Mantell, Raphael D Cohen, Sidney Kobrin, Jesse L Chittams, Scott O Trerotola
• Journal: Journal of vascular and interventional radiology : JVIR (J Vasc Interv Radiol) Vol. 24 Issue 12 Pg. 1765-72; quiz 1773 (Dec 2013) ISSN: 1535-7732 [Electronic] United States
• PMID: 24409470 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Angioplasty, Balloon (adverse effects)
• Arteriovenous Shunt, Surgical (adverse effects)
• Blood Vessel Prosthesis Implantation (adverse effects)
• Chi-Square Distribution
• Female
• Graft Occlusion, Vascular (diagnosis, etiology, physiopathology, therapy)
• Humans
• Male
• Middle Aged
• Multivariate Analysis
• Proportional Hazards Models
• Renal Dialysis
• Retrospective Studies
• Risk Factors
• Thrombectomy (adverse effects, methods)
• Thrombosis (diagnosis, etiology, physiopathology, therapy)
• Time Factors
• Treatment Outcome
• Vascular Patency
• Young Adult