Transluminal angioplasty versus conventional operation in the treatment of haemodialysis fistula stenosis: Results from a 5-year study

Abstract

In this retrospective study we have used life table analysis to compare the results of 37 transluminal angioplasties with those of 37 conventional operations (thrombectomy, thrombendarterectomy with/without grafting, bypass) in the treatment of stenoses and occlusions of haemodialysis fistulae. There was no difference between the groups in terms of lesion morphology or the patients' age and sex. Cumulative patency rates for angioplasty and surgery, respectively, were 94.5 and 78.1 per cent after 1 week, 72.3 and 64.1 per cent after 1 month, 41.2 and 28.9 per cent after 5 months and 31.3 and 19.3 per cent after 1 year (X2 test, P less than 0.001). The difference is due mainly to a high percentage of early occlusions in the haemodialysis fistula stenoses is possible it achieves results which are at least as good as those of operation.

The Treatment of Chronic Hemodialysis Vascular Access by Directional Atherectomy

“…Therefore other therapeutic modalities such as PTA or DA have been examined because these methods are available as outpatient procedures and do not pre clude surgical revision at a later date. With regard to the patency period after PTA, the results of several investiga tors vary considerably: patency rates of 41-76% at 6 months have been reported [2,7,8], Our results with DA demonstrated a patency rate of 91 % at 6 months, and the average patency period was 10.3 months. The study by Zemel et al [5] is the only report describing the patency period after DA in hemodialyzed patients, and our results were more successful.…”

Endovascular versus Surgical Preemptive Repair of Forearm Arteriovenous Fistula Juxta-Anastomotic Stenosis

“…The surgical correction of stenosis-creating a more proximal neo-anastomosis (2,12,19,(22)(23)(24)(25)(26), vein-to-vein re-anastomosis (19,23), vein patching (12,23,26,27), or short vein (12,22,23,27) or PTFE graft interposition (12,19,24,26,27)-is a minimally invasive procedure in such easily accessible vessels, it does not use up a long segment of the vein, it involves minimal intimal trauma, and it is likely to be more durable than percutaneous transluminal angioplasty (PTA), because reported primary patency rates in surgical series are higher than after dilation (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(23)(24)(25)(26)28). Some investigators use PTA as the first-line treatment for these lesions, too, however, because it is less invasive and produces excellent immediate primary results …”

“…It also is remarkable that none of the few retrospective comparisons between surgery and endovascular radiology (reporting cumulative data for forearm and upper arm, or patent and thrombosed AVF) (12,27) has addressed specifically the issue of the optimal treatment modality for the preemptive correction of these lesions, so it still is not clear which treatment option should be applied for the treatment of juxta-anastomotic stenoses in forearm AVF, and guidelines suggest that each institution decide which procedure is best for its patients on the basis of the available expertise (1). We performed an analysis of prospectively and concurrently collected data to compare the outcome (restenosis and procedure failure rate) and cost of surgical versus endovascular preemptive repair of venous juxta-anastomotic stenoses (within the first 5 cm of the vein) in functioning, mature, virgin AVF located in the lower half of the forearm.…”

Axillofemoral Fistula for Hemodialysis Access

“…Combined approach seems to be the option for AF AVF thrombotic -stenotic complications solution. Surgical thrombectomy (using Fogarty baloon catheter) of ePTFE prosthesis is easy and interventional radiological anastomotic stenoses repair ( baloon angioplasty ) produces good results 19,[26][27][28][29] . Only local anesthesia and one incision as repair accesss are needed.…”