John Swinnen1, Kia Lean Tan2, Richard Allen2, David Burgess3, Irwin V Mohan2. 1. Vascular Surgery, Westmead Hospital, University of Sydney Medical School, Sydney, New South Wales, Australia. Electronic address: john_swinnen@bluebottle.com. 2. Vascular Surgery, Westmead Hospital, University of Sydney Medical School, Sydney, New South Wales, Australia. 3. Department of Cardiology, Blacktown Hospital, University of Sydney Medical School, Sydney, New South Wales, Australia.
Abstract
OBJECTIVE: This study describes our technique of aggressive angioplasty with juxta-anastomotic stenting (JXAS) in the autogenous arteriovenous fistula and reviews our outcomes with this technique in its mature form. METHODS: We developed a JXAS technique during the last 7 years. Since 2006, we have placed 135 JXASs. The study period reviews 68 consecutive JXASs placed from 2008 to 2012 using the mature technique. We retrospectively analyzed the prospectively collected data. Thirty-three fistulas received JXAS for failure to mature, and 35 were mature but inadequately dialyzing fistulas (problem fistulas). The JXAS technique involves (1) treating the JXA segment as a unit, (2) aggressive angioplasty with rupture of stenoses, and (3) placement of an uncovered nitinol stent. RESULTS: Technical success was 97%. Of the fistulas that had failed to mature, 75% were brought to maturity by 6 months and 88% by 12 months. Adequate dialysis was achieved in all 35 problem fistulas immediately postoperatively. Assisted fistula patency was 90% at 2 years and 80% at 4 years. CONCLUSIONS: JXAS is an effective technique for maturing and maintaining the wrist radiocephalic arteriovenous fistula. Crown
OBJECTIVE: This study describes our technique of aggressive angioplasty with juxta-anastomotic stenting (JXAS) in the autogenous arteriovenous fistula and reviews our outcomes with this technique in its mature form. METHODS: We developed a JXAS technique during the last 7 years. Since 2006, we have placed 135 JXASs. The study period reviews 68 consecutive JXASs placed from 2008 to 2012 using the mature technique. We retrospectively analyzed the prospectively collected data. Thirty-three fistulas received JXAS for failure to mature, and 35 were mature but inadequately dialyzing fistulas (problem fistulas). The JXAS technique involves (1) treating the JXA segment as a unit, (2) aggressive angioplasty with rupture of stenoses, and (3) placement of an uncovered nitinol stent. RESULTS: Technical success was 97%. Of the fistulas that had failed to mature, 75% were brought to maturity by 6 months and 88% by 12 months. Adequate dialysis was achieved in all 35 problem fistulas immediately postoperatively. Assisted fistula patency was 90% at 2 years and 80% at 4 years. CONCLUSIONS: JXAS is an effective technique for maturing and maintaining the wrist radiocephalic arteriovenous fistula. Crown
Authors: Riccardo Corti; Pietro Quaretti; Franco Galli; Lorenzo Paolo Moramarco; Nicola Cionfoli; Giovanni Leati; Riccardo Corbetta; Matteo Tozzi Journal: SAGE Open Med Case Rep Date: 2017-11-14