Venous rupture during percutaneous treatment of hemodialysis fistulas and grafts.

OBJECTIVES: The aim of this study was to analyze the risk and consequences of venous rupture during angioplasty of malfunctioning hemodialysis grafts and fistulas.
BACKGROUND: Venous stenoses in the outflow limb of hemodialysis accesses often require ultra-high balloon pressure for optimal dilatation.
METHODS: Baseline characteristics and outcomes were analyzed for a consecutive series of patients treated between 1999 and 2008.
RESULTS: Venous rupture or perforation occurred in 11 of 1242 (0.9%) procedures. No patient with a rupture or perforation died or required emergency or urgent surgical repair. Two of 11 patients (18.2%) required transfusions, 8 of 11 patients (72.7%) required stenting, and 6 of 8 (75.0%) who needed stenting received covered stents to achieve hemostasis. Rupture led to access thrombosis within 30 days in 9 of 11 cases (82%). Multivariable logistical regression analysis suggested that using a balloon catheter more than 2 mm larger than the diameter of the hemodialysis access or using peripheral cutting balloons increased the risk of rupture or perforation.
CONCLUSIONS: Rupture or perforation is a rare complication of treatment of malfunctioning hemodialysis grafts and fistulas. The complication may be managed with nonsurgical methods and might be avoided by optimal balloon selection and sizing.