Abstract:
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Purpose: To determine the prevalence of stenoses in dysfunctional autogenous hemodialysis fistulas, patency following angioplasty and to identify predictors of this patency.
Methods and Materials: We retrospectively reviewed our institutional experience with autogenous fistulas from June 1997 to June 2002. A total of 151 dysfunctional fistulas (94 radiocephalic and 57 brachiocephalic fistulas) were treated with 299 angioplasties and four declottings performed. Patency following angioplasty was estimated by the Kaplan Meier method and predictors of patency were determined using a Cox proportion hazard model. Factors examined were age, anatomic location and type of fistula, sex and diabetes. Time to first angioplasty from time of fistula creation and the number of venous stenosis was also examined to determine if these variables influenced outcome.
Results: Clinical success was 98%. Primary patency at 3, 6 and 12 months (+/- SE) was 73% (6%), 51% (7%) and 39% (7%) for brachiocephalic fistulas. Primary patency at 3, 6 and 12 months (+/- SE) was 85% (4%), 75% (5%) and 62% (5%) for radiocephalic fistulas. Secondary patency at 3, 6, and 12 months for brachiocephalic fistulas was 96% (2.4%), 89% (4%) and 85% (5%). For radiocephalic fistulas the 3,6 and 12 month seconday patencies were 91% (3%), 88% (3%) and 86% (4%). There was a significant difference in primary patency between radiocephalic and brachiocephalic fistulas (log-rank test, p=0.0042) but not for secondary patency (log-rank test, p=0.45). Stenosis was most prevalent within 3cm of the arteriovenous anastomosis in 64% of dysfunctional radiocephalic fistulas and the cephalic arch (30.3%) for dysfunctional brachiocephalic fistulas. Patient age, age of the fistula prior to initial intervention, diabetes, side and location of the fistula, location of stenosis and number of venous stenosis dilated did not influence outcome (primary and secondary patency). Complications occurred in 2.3% of interventions.
Conclusion: Patency following angioplasty in dysfunctional autogenous hemodialysis fistulas exceeds that observed in hemodialysis grafts and exceeds the DOQI guidelines. None of the clinical and anatomic variables examined influenced outcome.
Questions about this event email: dheeraj.rajan@uhn.on.ca
Bunston, S,
Prevalence of Stenosis in Dysfunctional Autogenous Native Fistulas and Outcome Following Percutaneous Angioplasty. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3100324.html
