BACKGROUND AND OBJECTIVES: Referring hemodialysis patients for elective access angiography and percutaneous transluminal angioplasty (PTA) is commonly done to prevent access failure, yet the effectiveness of this procedure remains unclear. DESIGN, SETTING, PARTICIPANTS, & MEASURES: An observational matched cohort analysis among 40,132 Medicare beneficiaries receiving hemodialysis with a fistula or graft was performed. Cox regression was used to determine whether access intervention was associated with improved 1-year access survival. RESULTS: Nonsurgical access intervention was found to be frequent at a rate of 20.9 procedures per 100 access years. In the 1-year period after intervention using angiography and PTA, the overall access failure rate was 53.7 per 100 access years in the intervention group and 49.6 in the nonintervention group (HR = 1.02; 95% CI, 0.96 to 1.08). Similar findings were also seen when the analysis was repeated in only fistulas (HR = 1.06; 95% CI, 0.98 to 1.15) and grafts (HR = 0.95; 95% CI, 0.86 to 1.05). In patients with a low intra-access flow rate (HR = 0.86; 95% CI, 0.75 to 0.99) or a new access (HR = 0.79; 95% CI, 0.71 to 0.89), angiography and PTA significantly increased access survival when compared with nonintervention (P for interaction was <0.0001). Angiography-PTA-related upper-extremity hematoma, vessel injury, or embolism-thrombosis occurred in 1.1% of all patients. CONCLUSIONS: Access characteristics significantly modify the survival benefits of angiography and PTA intervention where the benefits of these interventions are most seen in newer accesses or accesses with insufficient flow.
BACKGROUND AND OBJECTIVES: Referring hemodialysis patients for elective access angiography and percutaneous transluminal angioplasty (PTA) is commonly done to prevent access failure, yet the effectiveness of this procedure remains unclear. DESIGN, SETTING, PARTICIPANTS, & MEASURES: An observational matched cohort analysis among 40,132 Medicare beneficiaries receiving hemodialysis with a fistula or graft was performed. Cox regression was used to determine whether access intervention was associated with improved 1-year access survival. RESULTS: Nonsurgical access intervention was found to be frequent at a rate of 20.9 procedures per 100 access years. In the 1-year period after intervention using angiography and PTA, the overall access failure rate was 53.7 per 100 access years in the intervention group and 49.6 in the nonintervention group (HR = 1.02; 95% CI, 0.96 to 1.08). Similar findings were also seen when the analysis was repeated in only fistulas (HR = 1.06; 95% CI, 0.98 to 1.15) and grafts (HR = 0.95; 95% CI, 0.86 to 1.05). In patients with a low intra-access flow rate (HR = 0.86; 95% CI, 0.75 to 0.99) or a new access (HR = 0.79; 95% CI, 0.71 to 0.89), angiography and PTA significantly increased access survival when compared with nonintervention (P for interaction was <0.0001). Angiography-PTA-related upper-extremity hematoma, vessel injury, or embolism-thrombosis occurred in 1.1% of all patients. CONCLUSIONS: Access characteristics significantly modify the survival benefits of angiography and PTA intervention where the benefits of these interventions are most seen in newer accesses or accesses with insufficient flow.
Authors: Louise M Moist; David N Churchill; Andrew A House; Steven F Millward; James E Elliott; Stewart W Kribs; William J DeYoung; Lesley Blythe; Lawrence W Stitt; Robert M Lindsay Journal: J Am Soc Nephrol Date: 2003-10 Impact factor: 10.121
Authors: Sunanda J Ram; Jack Work; Gloria C Caldito; J Mark Eason; Aslam Pervez; William D Paulson Journal: Kidney Int Date: 2003-07 Impact factor: 10.612
Authors: Ming Teng; Myles Wolf; Edmund Lowrie; Norma Ofsthun; J Michael Lazarus; Ravi Thadhani Journal: N Engl J Med Date: 2003-07-31 Impact factor: 91.245
Authors: Sunanda J Ram; Raja Nassar; Jack Work; Kenneth Abreo; Neville R Dossabhoy; William D Paulson Journal: Am J Kidney Dis Date: 2008-10-08 Impact factor: 8.860
Authors: M Wolf; A Shah; O Gutierrez; E Ankers; M Monroy; H Tamez; D Steele; Y Chang; C A Camargo; M Tonelli; R Thadhani Journal: Kidney Int Date: 2007-08-08 Impact factor: 10.612