Factors associated with outcome after successful radiological intervention in arteriovenous fistulas: A retrospective cohort

Abstract

Introduction:Arteriovenous fistulas are the best form of vascular access for haemodialysis. A radiological balloon angioplasty is the standard treatment for a clinically relevant stenosis, but the recurrence rate is high. Data on factors associated with recurrence are limited.Methods:A single centre, retrospective analysis was performed for 124 consecutive patients who had successful interventions for dysfunctional arteriovenous fistulae, to examine factors associated with post-intervention patency. Follow-up was at least 1 year for all patients. Variables associated with primary and cumulative patency were pre-specified and assessed using both un-adjusted (univariate) and adjusted Cox proportional hazards models. Analysis was repeated for a subgroup of 80 patients with a single lesion only in order to examine the potential effects of stenotic lesion characteristics on patency.Results:Factors found to have a significant association with poorer outcomes (less time to loss of patency) included thrombosis at the time of intervention and a history of previous intervention. Fistula age (log days) was significantly associated with better outcomes (greater time to loss of patency). Non-white ethnicity, lesion length, and patient age were also significantly associated with accelerated loss of patency.Discussion:The factors we have identified as linked to poor outcome may help to identify patients in whom a balloon angioplasty is unlikely to provide a durable outcome. This may prompt exploring alternative treatment or dialysis options at an early stage.

Analysis of factors for post–percutaneous transluminal angioplasty primary patency rate in hemodialysis vascular access

“…In the present study, we demonstrated that blood flow volume after PTA was an important factor associated with primary patency after PTA. Previous studies found that primary patency after PTA was associated with AVF age, [5][6][7][8] upper arm AVF, 18 hypertension, 19 lesion length, 7,20 vessel disease score (a composite variable of diabetes, coronary artery disease, and peripheral vascular disease), 20 thrombosis, 8 diabetes, 9 asymmetrical dimethylarginine level, 9 low-density lipoprotein level, 9 calcium phosphate product, 19 urea reduction ratio, 19 and albumin level. 19 Almost no reports on primary patency after PTA mention blood flow volume.…”

“…Previously reported factors associated with VA patency include time since VA construction and diabetes. [5][6][7][8][9] In the present study, we investigated blood flow volume using ultrasonography before and after PTA, which has not been sufficiently studied, as well as factors previously found to be correlated with primary patency after the initial PTA following shunt construction in patients with AVF.…”

A multicenter randomized controlled trial indicates that paclitaxel-coated balloons provide no benefit for arteriovenous fistulas

“…The 6-month TLPP in the control group was 84.5% in the current trial, and this is higher than those reported in the other published trials 20,22 and most institutional case series. [4][5][6][7][8][9][10] The TLPP in the control arm of the study by Lookstein et al was only 59.5% at 6 months. 22 This underlines the value of a good balloon fistuloplasty in maintaining patency.…”

“…This is unlikely to explain the lower event rate in the current trial because previous data suggest that postintervention access circuit primary patency is similar in patients with multiple or single lesions. 7 However, stenoses at multiple sites in the access circuit are a common finding, and deciding which is clinically most significant can be subjective. We therefore only included patients with a stenosis at a single site in the circuit to be sure that this lesion was responsible for the clinical problem leading to intervention.…”

“…Retrospective studies have reported postintervention primary patency rates of around 60% to 70% at 6 months and 40% to 50% at 1 year. [4][5][6][7][8][9][10] Hence, more durable interventions are required to reduce restenosis rates.…”