Balloon Angioplasty Versus Surgical Revision for Thrombosed Dialysis Graft Outlet Stenosis After Graft Thrombectomy
Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan. Angiology
(Impact Factor: 2.97).
05/2010; 61(6):580-3. DOI: 10.1177/0003319710364211
It is important to correct underlying graft outlet stenosis after thrombectomy of dialysis grafts. This study retrospectively reviewed patients who received dialysis graft thrombectomy at this institution to compare the effectiveness of 2 different methods.
A total of 289 dialysis graft thrombectomy procedures performed during 2001-2003 were retrospectively reviewed. The results of 163 cases in balloon angioplasty group were compared with those of 129 patients who underwent outlet revision. Patient characteristics between the 2 groups were similar with regard to demographic characteristics and comorbidities (P > .05). The mean primary patency of balloon and revision groups are 7.23 +/- 7.38 and 8.35 +/- 9.53 (months), respectively. Survival curves for each group were calculated by Kaplan-Meier method. There was no difference between 2 groups regarding graft patency.
The result of dialysis graft outlet balloon angioplasty was comparable to that of surgical revision. Considering the invasiveness, balloon angioplasty should be considered when treating thrombosed dialysis grafts.
Available from: Konstantinos Moulakakis
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ABSTRACT: Most arteriovenous hemodialysis grafts fail ≤18 months after implantation, most commonly due to intimal hyperplasia at the venous anastomosis. This open prospective study compared balloon angioplasty vs nitinol stent placement in the treatment of venous anastomotic stenosis after thrombectomy of prosthetic brachial-axillary accesses.
Between February 2007 and December 2010, 61 patients with an initial thrombosis of a prosthetic brachial-axillary access were admitted to our hospital. Of these patients, 28 (46%), treated before June 2008, underwent thrombectomy plus balloon angioplasty of the venous anastomosis (group A), whereas the remaining 33 (54%) patients, who were treated after July 2008, underwent graft thrombectomy plus angioplasty with self-expanding nitinol stent placement (group B). Primary, primary-assisted, and secondary patency rates were calculated using Kaplan-Meier analysis and compared between the two groups with the log-rank test.
Primary patency was 32% at 3 months, 24% at 6 months, and 14% at 12 months in group A, and the respective values were 85%, 63% and 49% in group B. Primary patency was significantly better in group B than in group A (P < .001; log-rank test). Cumulative median patency was 60 days in group A and 260 days in group B. Patient age, sex, comorbidities, graft material, and graft age did not have prognostic significance. Primary-assisted and secondary patency rates were significantly higher in group B.
Graft thrombectomy plus angioplasty with self-expanding nitinol stent placement provides significantly higher patency rates compared with thrombectomy plus plain balloon angioplasty of the venous anastomosis.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 12/2011; 55(2):472-8. DOI:10.1016/j.jvs.2011.08.043 · 3.02 Impact Factor
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ABSTRACT: Percutaneous transluminal angioplasty (PTA) for thrombosed dialysis graft is both difficult and time-consuming that may increase radiation exposure. A predictor of PTA success and procedure time has not been identified yet. Sonography data and the PTA results of 88 grafts were reviewed retrospectively. The echogenicity of the majority of the intra-graft thrombus and the presence/absence of thrombus free space in the grafts were examined. The association between the sonography findings and PTA procedure success and procedure time was analyzed. The echogenicity of the intra-graft thrombus and presence/absence of thrombus free space were the major determinants of procedure success and procedure time. Higher intra-graft echogenicity and lack of thrombus free space were associated with more procedure failures (p < 0.01 vs. p = 0.04) and longer procedure times (p = 0.03 vs. p < 0.01). Thrombi from occluded dialysis grafts may differ in resistance to mechanical/pharmacological thrombolysis. Sonography characteristics of the intra-graft thrombus may help to differentiate them.
Ultrasound in medicine & biology 04/2012; 38(4):545-50. DOI:10.1016/j.ultrasmedbio.2012.01.016 · 2.21 Impact Factor
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ABSTRACT: Background: A well-established method to preserve failing synthetic arteriovenous grafts (AVGs) dialysis accesses is percutaneous transluminal angioplasty (PTA). Nevertheless, the one-year primary patency rate following PTA is approximately 25%. This study was designed to compare the angiographic and clinical outcomes following stent-graft insertion versus angioplasty and/or bare metal stenting (BMS) of recurrently failing AVGs, because of anastomotic and/or venous outflow stenoses. Methods: Self-expanding stent-grafts were deployed for the treatment of failing AVGs in case of recurrent stenosis after treatment with conventional angioplasty or bail-out BMS. Regular angiographic follow-up was scheduled every two months the first six months and every three months thereafter. Data from previous procedures on the same treatment site were retrieved from our database. Primary patency was defined as a functioning graft with a patent treatment site without angiographic restenosis >50% and without any subsequent repeat procedures. Outcome data were analyzed by Kaplan-Meier analysis. Results: In total, 35 patients previously treated with angioplasty and/or BMS for the treatment of recurrent significant AVG stenosis (group PTA), underwent stent-graft placement of the same treatment site (group SG). Of those, 20 patients had undergone angioplasty and 15 bail-out BMS. Mean lesion length was 4.8±1.7cm. Primary patency was significantly improved in the SG group (Hazard Ratio [HR] = 0.2 [95% CI= 0.11-0.36], P=.0001) by log-rank test. The estimated six and 12-month patency rates were 76.9% vs. 25.7%, and 61.4% vs. 8.6% for groups SG and PTA respectively, (P<.0001). Conclusions: Stent-graft placement significantly improves primary patency of anastomotic and venous outflow stenoses in recurrently failing prosthetic arteriovenous grafts.
Journal of nephrology 05/2012; 26(2). DOI:10.5301/jn.5000161 · 1.45 Impact Factor
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