Jie Cui1,2, Dihua Xu1, Jie Ma3, Bingyan Liu3, Tatsuo Kawai4, Heidi Yeh4, Robert Schainfeld5, Zubin Irani2. 1. Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA - USA. 2. Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA - USA. 3. Division of Nephrology, Department of Medicine, Peking Union Medical College Hospital, Beijing - China. 4. Division of Transplant Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA - USA. 5. Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA - USA.
Abstract
PURPOSE: Balloon angioplasty is the standard treatment for dysfunctional hemodialysis fistulas, but angioplasty response of stenotic lesions located in different segments of the dialysis circuit has not been explicitly evaluated. The purpose of this study is to describe the distribution of stenotic lesions in the most common types of arteriovenous fistulas and to investigate the response to balloon angioplasty of stenotic lesions located in various segments of the fistula circuit. MATERIALS AND METHODS: This single-center, retrospective study was approved by the Institutional Review Board. A total of 263 fistulograms performed between January, 2014 and June, 2015 were reviewed. Stenotic lesion response to angioplasty was analyzed based on lesion location using a Kaplan-Meier analysis. RESULTS: Juxta-anastomotic stenoses (48%) were the most common lesions in radiocephalic fistulas, while the cephalic arch (30%) and venous outflow tract (24%) were the most common locations of stenotic lesions in brachiocephalic fistulas and basilic vein transposition fistulas, respectively. Primary patency after balloon angioplasty was significantly higher in lesions located in the venous segments manipulated during surgeries compared to the lesions located in the surgically naive zone (p = 0.001). The 6-month and 12-month primary patency of lesions post-angioplasty in the surgical zone were 76% and 71% compared to 58% and 43% in the surgically naive segments. CONCLUSIONS: The distribution of stenotic lesions differs among each type of fistula. The primary patency of balloon angioplasty of stenotic lesions located in the surgically manipulated venous segment was significantly better than lesions located in the rest of the fistula circuit.
PURPOSE: Balloon angioplasty is the standard treatment for dysfunctional hemodialysis fistulas, but angioplasty response of stenotic lesions located in different segments of the dialysis circuit has not been explicitly evaluated. The purpose of this study is to describe the distribution of stenotic lesions in the most common types of arteriovenous fistulas and to investigate the response to balloon angioplasty of stenotic lesions located in various segments of the fistula circuit. MATERIALS AND METHODS: This single-center, retrospective study was approved by the Institutional Review Board. A total of 263 fistulograms performed between January, 2014 and June, 2015 were reviewed. Stenotic lesion response to angioplasty was analyzed based on lesion location using a Kaplan-Meier analysis. RESULTS: Juxta-anastomotic stenoses (48%) were the most common lesions in radiocephalic fistulas, while the cephalic arch (30%) and venous outflow tract (24%) were the most common locations of stenotic lesions in brachiocephalic fistulas and basilic vein transposition fistulas, respectively. Primary patency after balloon angioplasty was significantly higher in lesions located in the venous segments manipulated during surgeries compared to the lesions located in the surgically naive zone (p = 0.001). The 6-month and 12-month primary patency of lesions post-angioplasty in the surgical zone were 76% and 71% compared to 58% and 43% in the surgically naive segments. CONCLUSIONS: The distribution of stenotic lesions differs among each type of fistula. The primary patency of balloon angioplasty of stenotic lesions located in the surgically manipulated venous segment was significantly better than lesions located in the rest of the fistula circuit.