OBJECTIVE: To determine predictors of technical success, dysfunction recurrence and patency after percutaneous transluminal angioplasty (PTA) of de novo dysfunctional hemodialysis arteriovenous fistulas (AVFs). METHODS: Retrospective analysis of first time PTA of 167 AVF in 162 patients (100 men, 66±13 years). Anatomical (location, length, grade and number of stenoses) and clinical variables (sex, age, prior AVF, diabetes mellitus and AVF age, side and location) were reviewed. RESULTS: 217 stenoses or segmental occlusions were treated. Technical success rate (84.4%) was higher in radiocephalic AVF compared to brachial artery-median vein AVF (p=0.030) and was negatively correlated with initial stenosis (p=0.049). Dysfunction recurrence was seen in 52.7% and correlated negatively with technical success (p=0.013) and AVF age (p=0.008). Early dysfunction (within 6 months) was negatively correlated with AVF age (p=0.016) and positively with diabetes (p=0.003). Higher AVF age resulted in higher primary (p=0.005) and secondary patency rates (p=0.037-0.005). CONCLUSIONS: Technical success of PTA in hemodialysis AVF is affected by AVF type and initial stenosis and has significant effect on dysfunction recurrence, but not on AVF longevity. Younger AVF has increased risk for (early) recurrent dysfunction and lower patency rates. Patients with diabetes mellitus have higher risk for early dysfunction.
OBJECTIVE: To determine predictors of technical success, dysfunction recurrence and patency after percutaneous transluminal angioplasty (PTA) of de novo dysfunctional hemodialysis arteriovenous fistulas (AVFs). METHODS: Retrospective analysis of first time PTA of 167 AVF in 162 patients (100 men, 66±13 years). Anatomical (location, length, grade and number of stenoses) and clinical variables (sex, age, prior AVF, diabetes mellitus and AVF age, side and location) were reviewed. RESULTS: 217 stenoses or segmental occlusions were treated. Technical success rate (84.4%) was higher in radiocephalic AVF compared to brachial artery-median vein AVF (p=0.030) and was negatively correlated with initial stenosis (p=0.049). Dysfunction recurrence was seen in 52.7% and correlated negatively with technical success (p=0.013) and AVF age (p=0.008). Early dysfunction (within 6 months) was negatively correlated with AVF age (p=0.016) and positively with diabetes (p=0.003). Higher AVF age resulted in higher primary (p=0.005) and secondary patency rates (p=0.037-0.005). CONCLUSIONS: Technical success of PTA in hemodialysis AVF is affected by AVF type and initial stenosis and has significant effect on dysfunction recurrence, but not on AVF longevity. Younger AVF has increased risk for (early) recurrent dysfunction and lower patency rates. Patients with diabetes mellitus have higher risk for early dysfunction.
Authors: Narayan Karunanithy; Irene Rebollo Mesa; Anthony Dorling; Francis Calder; Konstantinos Katsanos; Vikki Semik; Emily Robinson; Janet Peacock; Neelanjan Das; Colin Forman; Sarah Lawman; Kate Steiner; C Jason Wilkins; Michael G Robson Journal: Trials Date: 2016-05-12 Impact factor: 2.279