Staff Members - Benha University
Sometimes endovascular salvage of failing hemodialysis access is indispensable as you may not get another
• 2016
Publication Information
Authors
Hisham Ahmed, El-Sayed A. Abd El-Mabood, Refaat S. Salama
Keywords
endovascular salvage, failing hemodialysis access, outcomes
Journal
Not Available
Publisher
Not Available
Volume
Not Available
Issue
Not Available
Pages
Not Available
publication.type
Local
Paper Link
Not Available
Supplementary Materials
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Abstract
Purposes
This study aimed at salvaging fistulas using percutaneous transluminal balloon
angioplasty (PTA) and evaluated the feasibility and safety of this PTA.
Patients and methods
A retrospective study was conducted on 15 patients to evaluate the results of
endovascular intervention for the treatment of failing arteriovenous fistula from
August 2015 until March 2016; these patients included eight (53.3%) men and
seven (46.7%) women; most patients were aged between 40 and 60 years.
Results
Immediate success rate was 66.4% in anastomotic stenosis, 75% in juxtaanastomotic
stenosis, and 100% in cases of central venous and arterial
stenosis. Success rate after 6 months was mostly 50%, which necessitated re-
PTA, except in central stenosis cases, which showed a success of 100%. Failed
procedure was observed in three cases; two were due to puncture site hematoma
and vein or anastomotic site rupture; these were treated with open surgery and
ligation of the artery and vein proximal and distal to the anastomosis. Thrombosis
was the cause of failure in the third case.
Conclusion
From this study we conclude that saving access can save life. Failing arteriovenous
fistulas can be salvaged with PTA safely and effectively. Results are obtained with
less trauma to the patient, preservation of access sites, and less postprocedural
pain and wound edema. Centrally located stenoses are accessible. Re-PTA is
needed in half of the patients.
This study aimed at salvaging fistulas using percutaneous transluminal balloon
angioplasty (PTA) and evaluated the feasibility and safety of this PTA.
Patients and methods
A retrospective study was conducted on 15 patients to evaluate the results of
endovascular intervention for the treatment of failing arteriovenous fistula from
August 2015 until March 2016; these patients included eight (53.3%) men and
seven (46.7%) women; most patients were aged between 40 and 60 years.
Results
Immediate success rate was 66.4% in anastomotic stenosis, 75% in juxtaanastomotic
stenosis, and 100% in cases of central venous and arterial
stenosis. Success rate after 6 months was mostly 50%, which necessitated re-
PTA, except in central stenosis cases, which showed a success of 100%. Failed
procedure was observed in three cases; two were due to puncture site hematoma
and vein or anastomotic site rupture; these were treated with open surgery and
ligation of the artery and vein proximal and distal to the anastomosis. Thrombosis
was the cause of failure in the third case.
Conclusion
From this study we conclude that saving access can save life. Failing arteriovenous
fistulas can be salvaged with PTA safely and effectively. Results are obtained with
less trauma to the patient, preservation of access sites, and less postprocedural
pain and wound edema. Centrally located stenoses are accessible. Re-PTA is
needed in half of the patients.