Incidence and Management of Percutaneous Transluminal Angioplasty-induced Venous Rupture in the "Fistula First" Era
ABSTRACT Percutaneous transluminal angioplasty (PTA)-induced venous rupture is a common complication of hemodialysis access interventions. The authors sought to determine if venous rupture rates and management differed between grafts and fistulas, and in the fistula subset, between transposed and nontransposed fistulas.
Patients experiencing venous rupture during hemodialysis PTA over a 5-year period were identified. Of 1,985 hemodialysis interventions, 75 ruptures occurred in 69 patients (46 women) with a mean age of 63 years (range, 31-88 y). Rupture rates, proportion of successful treatments, and treatment type and number (ie, balloon tamponade, stent, covered stent) were determined.
Rupture was more common in fistulas overall (5.6%, 39 of 693) compared with grafts (2.8%, 36 of 1,292; P = .002), in transposed (10.7%, 20 of 187) compared with nontransposed fistulas (3.8%, 19 of 506; P = .001), and in transposed fistulas compared with grafts (P = .0001). There was no significant difference between nontransposed fistulas and grafts. Treatment success (ie, resolution of extravasation) was the same among groups: 69% (27 of 39) in fistulas overall, 70% (14 of 20) in transposed fistulas, 68% (13 of 19) in nontransposed fistulas, and 72% (26 of 36) in grafts. There was a greater need for stents in grafts (38.9%, 14 of 36) compared with fistulas (12.8%, five of 39; P = .003).
PTA-induced rupture is more common in fistulas than grafts, and this effect seems nearly entirely driven by transposed fistulas. Although rupture treatment in fistulas of all types yielded similar success to grafts, and graft ruptures were more difficult to treat than fistula ruptures, the high rupture rates in transposed fistulas attest to the increased difficulty of treating this subset of fistulas.
- [Show abstract] [Hide abstract]
ABSTRACT: The surgically placed dialysis arteriovenous fistula (AVF) is considered by the Kidney Disease Outcomes Quality Initiative (KDOQI)and the Fistula First Breakthrough Initiative to be the ideal choice for hemodialysis access. A significant number of newly placed AVFs either slowly or never adequately mature sufficiently to provide for adequate dialysis. The balloon-assisted maturation (BAM) procedure utilizes serial angioplasty to promote and accelerate AVF maturation. We present a minimally invasive AVF maturation technique utilizing angioplasty, stent-graft, and coil embolization. A 41-year-old white woman presented with an nonmaturing AVF with multiple venous outflow channels. An adequately functioning AVF was achieved after 2 treatments including coil embolization, angioplasty, and stent-graft placement. Adequate thrill and dialysis flow was achieved. Patient has done well during short-term follow-up without further intervention. BAM techniques can be an effective tool to help a dialysis patient achieve an adequately mature AVF. Additional vascular interventional techniques may be utilized to further improve clinical results. For the purpose of this report we call this technique "augmented balloon-assisted maturation," or aBAM.The journal of vascular access 11/2010; 12(1):9-12. DOI:10.5301/JVA.2010.6018 · 1.02 Impact Factor
- Journal of vascular and interventional radiology: JVIR 10/2011; 22(10):1488-9. DOI:10.1016/j.jvir.2011.02.035 · 2.15 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: PURPOSE: Cephalic arch stenosis (CAS) is an important and common cause of dysfunction in autogenous haemodialysis fistulas that requires multiple reinterventions and aggressive surveillance. We evaluated the safety and efficacy of the Viabahn stent-graft for the management of CAS. METHODS: Between April 2005 and October 2011, 11 consecutive patients [four men and seven women (mean age 56.7 years)] with CAS and dysfunctional fistulas were treated with insertion of 11 Viabahn stent-grafts. Six stent-grafts were inserted due to residual stenosis after angioplasty and five for fistuloplasty-induced rupture. No patient was lost to follow-up. RESULTS: The technical and clinical success rate was 100 %. Primary access patency rates were 81.8 % [95 % confidence interval (CI) 0.482-0.977] at 6 months and 72.7 % (95 % CI 0.390-0.939) at 12 months. Secondary access patency rates were 90.9 % at 6 months (95 % CI 0.587-0.997). There were no procedure-related complications. Mean follow-up was 543.8 days (range 156-2,282). CONCLUSION: The use of the Viabahn stent-graft in the management of CAS is technically feasible and, in this small series, showed patency rates that compare favorably with historical data of angioplasty and bare stents.CardioVascular and Interventional Radiology 06/2012; DOI:10.1007/s00270-012-0433-x · 1.97 Impact Factor