Andre Barranda Bautista MD, Presenter: Nothing to Disclose

Waleska Michelle Pabon-Ramos MD, Abstract Co-Author: Nothing to Disclose

Michael Joseph Miller MD, Abstract Co-Author: Speaker, Cook Group Incorporated Speaker, Boston Scientific Corporation Advisory Board, Boston Scientific Corporation Advisory Board, C. R. Bard, Inc Speaker, Kimberly-Clark Corporation

Paul Vincent Suhocki MD, Abstract Co-Author: Nothing to Disclose

Tony Preston Smith MD, Abstract Co-Author: Nothing to Disclose

Charles Yoon Kim MD, Abstract Co-Author: Consultant, CareFusion Corporation Research Grant, Galil Medical Ltd Consultant, Kimberly-Clark Corporation Consultant, Cryolife, Inc

While endovascular outcomes on venous anastomosis and central venous stenoses have been extensively studied, there is a paucity of data on intragraft stenoses. The purpose of this study was to evaluate outcomes of endovascular treatment of intragraft stenosis in prosthetic hemodialysis grafts.

Our procedural database was retrospectively reviewed for all percutaneous interventions on prosthetic AV grafts from 2005 through 2011. Specifically, AV grafts presenting with first-time intragraft interventions were identified, resulting in 186 unique AV grafts (83 males, 103 females, mean age 59.7 years). An intragraft stenosis was defined as a 50%+ luminal narrowing greater than 2 cm from the arterial and venous anastomosis requiring intervention. Post-intervention access patencies were calculated using Kaplan-Meier analysis. Lesion patency was determined based on time until angiographically proven >50% restenosis of the treated lesion.

Development of the first intragraft stenosis within an access occurred at a median graft age of 20.7 months (interquartile range 12.0-33.9 months). A total of 231 first-time intragraft stenoses were identified in 186 AV grafts. Graft thrombosis was present in 63%. Angioplasty was technically successful in 86%; 14% requiring stenting due to inadequate response to angioplasty. A concurrent extragraft stenosis was identified in 76% of accesses. At 3, 6, and 12 months, the post-intervention primary patency rates were 56%, 40%, and 23%, respectively. At 3, 6, and 12 months, secondary patency rates were 84%, 77%, and 67%, respectively. The lesion-specific patency rates were 78%, 52%, and 30% at 3, 6, and 12 months, respectively. Graft thrombosis was associated with significantly worse primary patencies (32% versus 53% at 6 months, p=0.014) but not secondary or lesion patency rates. Angioplasty and bailout stenting had similar patency rates. Graft age did not correlate with patency rates.

Angioplasty was highly successful for treatment of intragraft stenoses. Percutaneous intervention on these first-time intragraft stenosis yielded 6-month primary, secondary, and lesion patency rates of 40, 77, and 52%, respectively.

Percutaneous interventions on first-time intragraft stenoses yielded post-intervention patency rates that exceed the goals stated by the 2006 K/DOQI guidelines and are thus justified.

Bautista, A, Pabon-Ramos, W, Miller, M, Suhocki, P, Smith, T, Kim, C, Percutaneous Interventions on Intragraft Stenoses within Failing Prosthetic Arteriovenous Grafts: Analysis of Patency Rates.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14012139.html