Endovascular Treatment of Juxta-anastomotic Venous Stenoses of Forearm Radiocephalic Fistulas: Long-term Results and Prognostic Factors

Mortamais, J.; Papillard, M.; Girouin, N.; Boutier, R.; Cougnaud, Laure; Martín, Xavier; Badet, Lionel; Juillard, Laurent; Rouvière, Olivier

doi:10.1016/j.jvir.2012.12.004

Cited by 36 publications

(24 citation statements)

References 32 publications

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“…Inclusion criteria were as follows: age between 18 and 75 years, clinical signs of access dysfunction that having angiographically or ultrasonographically documented hemodynamically significant de novo stenosis (insufficient arterial line flow during dialysis) of the radiocephalic AVF (defined as at least 50% reduction in the diameter of the AVF compared to the most proximal non-aneurysmatic venous part), 7 having mature fistulas with proper technical and clinical success, and having complete follow-up data for 12 months. Exclusion criteria were as follows: the presence of pregnancy, active malignancy, previous endovascular therapy for juxta-anastomotic stenosis, and known hypersensitivity to iodine contrast agent or lidocaine.…”

Section: Methodsmentioning

confidence: 99%

A retrospective comparison analysis of results of drug-coated balloon versus plain balloon angioplasty in treatment of juxta-anastomotic de novo stenosis of radiocephalic arteriovenous fistulas

et al. 2019

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Background: Juxta-anastomotic stenosis is a common issue of arteriovenous fistulas. We aimed to evaluate the results of percutaneous transluminal angioplasty with drug-coated balloon versus plain balloon for the treatment of juxta-anastomotic stenoses of mature but failing distal radiocephalic arteriovenous fistulas. Methods: A total of 80 patients with a juxta-anastomotic stenosis of distal radiocephalic arteriovenous fistula in our clinic between January 2016 and September 2017 were retrospectively analyzed. Patients were divided into two groups according to the type of treatment as drug-coated balloon – percutaneous transluminal angioplasty (n = 44) and plain balloon – percutaneous transluminal angioplasty (n = 43). Intra- and post-procedural data were recorded. Target lesion primary patency rate was evaluated at 6 and 12 months. Of all patients, 48 were females and 39 were males with a mean age of 56.3 ± 10.4 (range, 24–75) years. Both groups had mature fistulas, and the mean age of fistula was 11.3 ± 9.1 months in the drug-coated balloon – percutaneous transluminal angioplasty group and 10.3 ± 8.8 months in the plain balloon – percutaneous transluminal angioplasty group (p = 0.24). Results: There was no significant difference in the target lesion stenosis rate and the median lesion length between the groups. Technical and clinical success were achieved in both groups. Target lesion primary patency was similar at 6 months between the two groups (93.1% vs 81.3%, respectively; p = 0.14) but significantly higher for the drug-coated balloon – percutaneous transluminal angioplasty group at 12 months (81.8% vs 51.1%, respectively; p = 0.01). Conclusion: Our study results suggest that the use of drug-coated balloon combined with percutaneous transluminal angioplasty is an effective treatment for juxta-anastomotic stenoses of mature but failing distal radiocephalic arteriovenous fistulas with significantly improved target lesion primary patency rates and reduced need for juxta-anastomotic reinterventions.

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Section: Methodsmentioning

confidence: 99%

A retrospective comparison analysis of results of drug-coated balloon versus plain balloon angioplasty in treatment of juxta-anastomotic de novo stenosis of radiocephalic arteriovenous fistulas

et al. 2019

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“…The juxta-anastomotic site was defined as the region within the first 2-5 cm of the outflow vein. 18 Thrombotic segments were classified based on the location as anastomosis or venous site. The control group was also assessed by the same radiologists in accordance with the same criteria used for the stenotic or thrombotic group.…”

Section: Imaging Analysismentioning

confidence: 99%

Relationship of arteriovenous fistula stenosis and thrombosis with the platelet–lymphocyte ratio in hemodialysis patients

2019

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Background: The platelet–lymphocyte ratio, which was reported to have a strong relationship with chronic inflammation and thrombosis, is a useful biomarker. The purpose of this study was to evaluate the relationship between the platelet–lymphocyte ratio, arteriovenous stenosis, and thrombosis in patients with chronic renal failure. Methods: Patients who were referred to our interventional radiology department due to arteriovenous fistula dysfunction from dialysis units between August 2015 and December 2018 were retrospectively reviewed. In the study, 95 patients with arteriovenous fistula access problems were included. Patients were divided into two groups: stenosis ( n = 52) and thrombosis ( n = 43). Thirty-six subjects with a patent left radiocephalic arteriovenous fistula proven by both color Doppler ultrasonography and clinically were added to the control group. Blood samples were obtained on the same day before the fistulography. Results: Platelet counts, lymphocyte counts, and platelet–lymphocyte ratio were found to be significantly different between the three groups. After the Bonferroni post hoc analysis, there was a significant difference between the stenosis and control group ( p = 0.017), and the thrombosis and control group ( p < 0.001) in terms of the platelet–lymphocyte ratio. No significant difference for any parameter was found between stenosis and thrombosis group. Conclusion: High levels of the platelet–lymphocyte ratio may be a supportive finding of arteriovenous fistula stenosis and thrombosis and can be taken into consideration during hemodialysis-dependent patients’ follow-up.

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“…There are some important considerations required prior to stent placement. For juxta-anastomotic stenosis in radiocephalic AVFs, surgical revision with formation of a more proximal anastomosis may be preferred because there is an adequate length of cephalic vein available for cannulation in comparison to upper arm AVFs [ 28 ]. Juxta-anastomotic stenosis in upper arm access is often located at the elbow flexure crease, which can make stents prone to fractures [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

Endovascular Stent Placement for Hemodialysis Arteriovenous Access Stenosis

Neuen

Baer

Grainer

et al. 2015

International Journal of Vascular Medicine

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This study aims to report the outcomes of nitinol and polytetrafluoroethylene covered stent placement to treat hemodialysis arteriovenous access stenosis at a single center over a five-year period. Clinical and radiological information was reviewed retrospectively. Poststent primary and secondary patency rates were determined using Kaplan-Meier analysis. Ten clinical variables were subjected to multivariate Cox regression analysis to determine predictors of patency after stent placement. During the study period 60 stents were deployed in 45 patients, with a mean follow-up of 24.5 months. The clinical and anatomical success rate was 98.3% (59/60). Poststent primary patency rates at 6, 12, and 24 months were 64%, 46%, and 35%, respectively. Poststent secondary patency rates at 6, 12, and 24 months were 95%, 89%, and 85%, respectively. Stent placement for upper arm lesions and in access less than 12 months of age was associated with reduced primary patency (adjusted hazards ratio [HR] 5.1, p = 0.0084, and HR 3.5, p = 0.0029, resp.). Resistant or recurrent stenosis can be successfully treated by endovascular stent placement with durable long-term patency, although multiple procedures are often required. Stent placement for upper arm lesions and in arteriovenous access less than 12 months of age was associated with increased risk of patency loss.

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Endovascular Treatment of Juxta-anastomotic Venous Stenoses of Forearm Radiocephalic Fistulas: Long-term Results and Prognostic Factors

Cited by 36 publications

References 32 publications

A retrospective comparison analysis of results of drug-coated balloon versus plain balloon angioplasty in treatment of juxta-anastomotic de novo stenosis of radiocephalic arteriovenous fistulas

A retrospective comparison analysis of results of drug-coated balloon versus plain balloon angioplasty in treatment of juxta-anastomotic de novo stenosis of radiocephalic arteriovenous fistulas

Relationship of arteriovenous fistula stenosis and thrombosis with the platelet–lymphocyte ratio in hemodialysis patients

Endovascular Stent Placement for Hemodialysis Arteriovenous Access Stenosis

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