Efficacy of ultrasound-guided percutaneous transluminal angioplasty for arteriovenous fistula stenosis or occlusion at juxta-anastomosis: A 3-year follow-up cohort study.

Abstract

OBJECTIVE:

Arteriovenous fistula (AVF) is the preferred access for hemodialysis. Percutaneous transluminal angioplasty (PTA) has become a choice for AVF stenosis, and ultrasound has been used in PTA more frequently.

METHODS:

This single-center retrospective cohort study analyzed 129 patients who underwent PTA in the First Affiliated Hospital of Chongqing Medical University from January 2016 to December 2016. Angioplasty was performed using a noncompliant high-pressure balloon. The process was visualized by duplex scan. Our inclusion criteria were as follows: (1) stenoses or occlusions were located at the juxta-anastomosis site: the first 5 cm of the vein distal to the anastomosis; (2) stenosis was confirmed with the following conditions: (a) flow rates are <500 mL/min in the brachial artery and <200 mL/min in the fistula during dialysis, and (b) the stenosis diameter is <1.7 mm. We used the Kaplan-Meier curve to show the postintervention primary and secondary patency rates of patients with stenosis and occlusion.

RESULTS:

Altogether, 129 patients with 76 males were analyzed. Moreover, 104 have AVFs on the left arm, and only one patient had an ulnar-basilic AVF, whereas others had a radial-cephalic AVF. The postintervention primary patency rates are better in occlusion cases (P < .05), whereas secondary patency rates have no difference. The postintervention primary patency rates are better in patients without diabetes mellitus (P < .05), whereas the secondary patency rates had no difference.

CONCLUSIONS:

For juxta-anastomosis site stenosis or occlusion, PTA can be used to obtain satisfactory results.

• Authors: Hui Gu, Ziming Wan, Qi-Quan Lai, Yu Zhou, Bo Tu, Bo Hu, Ling Chen, Xue-Jing Gao
• Journal: Journal of vascular surgery (J Vasc Surg) Vol. 74 Issue 1 Pg. 217-224 (07 2021) ISSN: 1097-6809 [Electronic] United States
• PMID: 33340700 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Angioplasty, Balloon (adverse effects)
• Arteriovenous Shunt, Surgical (adverse effects)
• Female
• Follow-Up Studies
• Graft Occlusion, Vascular (diagnostic imaging, etiology, physiopathology, therapy)
• Humans
• Male
• Middle Aged
• Renal Dialysis
• Retrospective Studies
• Time Factors
• Treatment Outcome
• Ultrasonography, Doppler, Duplex
• Ultrasonography, Interventional
• Upper Extremity (blood supply)
• Vascular Patency