Feasibility of routine ultrasound-guided percutaneous transluminal angioplasty in the treatment of native arteriovenous fistula dysfunction

Abstract

Background: Stenosis is the main cause of arteriovenous fistula failure and is due to neointimal hyperplasia. Percutaneous transluminal angioplasty is the gold standard for patients with vascular access stenosis. The aim of the study was to evaluate the efficacy and safety of ultrasound-guided percutaneous transluminal angioplasty in the treatment of native arteriovenous fistula venous stenosis. Methods: The need for intervention was determined by physical examination and duplex ultrasound in 162 patients. All patients with failing or not maturing arteriovenous fistula were treated in the outpatient setting under ultrasound guidance. Procedural success was assessed with repeated post-procedural ultrasound examinations. All procedures were performed under local anesthesia by a single nephrologist and were performed in a single vascular laboratory, while follow-up ultrasound was performed in the dialysis unit of destination. Results: Early technical success was obtained in 95.6% of cases (154 of 162). Complications occurred in 22 patients (13.5%) with no major complication requiring surgical or fluoroscopic endovascular intervention. Primary patency at 6 and 12 months was 84% and 69.8%, respectively. Risk factors for arteriovenous fistula failure/secondary percutaneous transluminal angioplasty were vascular access low blood flow rate and vintage, as well as the need for thrombolysis during the first percutaneous transluminal angioplasty. Conclusion: Ultrasound-guided percutaneous transluminal angioplasty is a valuable tool to treat vascular access stenosis.

Factors affecting the primary patency of native arteriovenous fistulas after ultrasound-guided percutaneous transluminal angioplasty

“…Primary patency rates at 6, 12, and 24 months were 87.7%, 75.8%, and 60.0%, respectively. These results are comparable to those reported in other literature [ 15 , 16 ], and also demonstrate the safety and effectiveness of UG-PTA.…”

“…A previous study demonstrated that only reliable predictor of postintervention secondary patency loss was previously unsuccessful and abandoned AVF [ 12 ]. No similar finding was seen in any of the other studies that evaluated the predictors of postintervention primary patency [ 14 , 16 , 43 ]. It is probable that several factors relating to patient selection and standard surgical procedures played a part in the current study.…”

“…Similarly, regardless of the number of additional interventions, postintervention secondary patency is defined as the interval from the first PTA until AVF failure or study conclusion [ 23 ]. Individuals were considered to have AVF dysfunction if their venous lumen diameter decreased by more than 50%, their access blood flow decreased by more than 25% from the previous assessment, and their peak systolic velocity (PSV) ratio between stenotic and pre-stenotic area was larger than 2 [ 16 ]. Complications were classified as major or minor according to the criteria of the Society of Cardiovascular and Interventional Radiology [ 24 ].…”

“…It is reported that the success rate of UG-PTA is 93–97.1% [ 15–17 ], which is higher than that of the traditional ones. However, these studies on usefulness of UG-PTA have short follow-up time and relatively small sample size [ 16 , 18 , 19 ]. Besides, the studies of affecting primary patency of AVF following UG-PTA were contradictory [ 20–22 ].…”

Sharp needle reconstructs peripheral outflow for patients with malfunctional arteriovenous fistula

“…Currently, percutaneous transluminal angioplasty (PTA) is the primary management of malfunctional AVF, such as immature fistula [ 5 ], stenosis of fistula caused by neointimal hyperplasia [ 6 , 7 ], stenosis or occlusion of juxta-anastomosis [ 8 ], and AVF thrombosis [ 9 ].…”