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Survival and Outcomes of Native ArteriovenousFistulas following Percutaneous Transluminal Angioplasty in the Haemodialysis Population in Dumfries and Galloway
EP30557
Poster Title: Survival and Outcomes of Native ArteriovenousFistulas following Percutaneous Transluminal Angioplasty in the Haemodialysis Population in Dumfries and Galloway
Submitted on 08 Sep 2019
Author(s): Jia Hong, Nadeeka Rathnamalala
Affiliations: Dumfries and Galloway Royal Infirmary
This poster was presented at BIR Annual Congress 2019
Poster Views: 57
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Poster Information
Abstract: Introduction

Native arteriovenous fistulas (AVF) are the preferred vascular access for dialysis patients. Significant stenosis are a common problem with AVF, requiring percutaneous procedures to re-establish patency. Patency following percutaneous intervention is highly variable. The aim of this study was to determine the patency rates of AVF following percutanous transluminal angioplasty (PTA) and to assess the clinical and anatomical factors associated with this in the dialysis population in Dumfries

Methods

A retrospective analysis of records of those who underwent first time PTA for a dysfunctional AVF. Anatomical (location and number of stenoses) and clinical factors (gender, age, presence of diabetes mellitus and AVF type) were reviewed. Statistical analysis was carried out to detect any significant correlation between these factors and the patency rates following PTA.

Results

A total of 44 AVF were included in this study. 63.6% of the AVFs referred for PTA were left sided and were predominantly radiocephalic fistulas (54.5%). Juxta-anastomotic and draining vein stenosis (81.8%) were the commonest lesions. Technical success was achieved in 95.5% of stenosis (n=42). Clinical success was 79.5% (n=35). Both were not correlated with clinical factors. Primary patency at 1, 2 and 3 years were 38.1%, 30% and 25% respectively. Secondary patency at 1, 2 and 3 years were 66.7%, 50% and 37.5% respectively. No correlation was detected between the clinical factors and patency rates.

Conclusions

While technical success is higher in our population, this does not seem to translate to higher clinical success or patency rates. This is possibly related to shear stress or technique during PTA. This highlights the need to review our procedural practices in comparison to other centres with better clinical success.
Summary: Radiocephalic fistulas require the most number of interventions, with juxta-anastomotic and draining vein lesions predominating. While technical success is higher in our population, this does not seem to translate to clinical success. This is possibly related to vascular inflammation after PTA, which has been identified as a major contributory factor to the restenotic processReferences: 1. National Kidney Foundation - Dialysis Outcomes Quality Initiative. NKFDOQI clinical practice guidelines for vascular access. Am J Kidney Dis 1997; 30(Suppl 3): 150–191.
2. Turmel-Rodrigues L, Pengloan J, Baudin S, et al. Treatment of stenosis and thrombosis in haemodialysis fistulas and grafts by interventional radiology. Nephrol Dial Transplant 2000; 15:2029–2036.
3. Clark TWI, Hirsch DA, Jindal KJ, Veugelers PJ, LeBlanc J. Outcome and prognostic factors of restenosis after percutaneous treatment of native hemodialysis fistulas. J Vasc Interv Radiol 2002; 13:51–59.
4. Heye S, Maleux G, Vaninbroukx J, Claes K, Kuypers D, Oyen R. Factors influencing technical success and outcome of percutaneous balloon angioplasty in de novo native hemodialysis arteriovenous fistulas. Eur J Radiol 2012; 81:2298–2303.
5. Aktas A, Bozkurt A, Aktas B. Percutaneous transluminal balloon angioplasty in stenosis of native haemodialysis arteriovenous fistula. Interventional Radiology 2015; 21
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