Background: Early detection and percutaneous treatment of stenosis
and thrombosis of hernodialysis access either native fistula (AVF) or graft
can prolong the use of these shunts.
Purpose: The study is designed to investigate the role of interventional
radiological procedures in treatment offailed hemodialysis access.
Methods: Between year 2003 and 2006, 19 patients with upper limb
shunts were subjected for multiple diagnostic angiographic procedures for
their failing hemodialysis access. Detection of thrombosis or stenosis
was followed by interval complex treatment. For all patients; 11 thrombolytic
therapies. 29 dilations and 5 stent placements were done. These
were performed in 13 native fistulas (9 forearms. 4 upper arm) and 6
prosthetic grafts. Restenosis and rethrombosis were treated by consecutive
red ilation and further declotting.
Results: The dysfunction was related to the venous side of hemodialysis
access in 90% of patients while it was on the arterial side in only
10%. The initial interventional success rate was 88% in the forearm.
100% in upper arm and 83% in grafts. The complications were mild and
transient including 4 hematomas at puncture sites. 4 consequent access
infection and 2 arrhythmic episodes; all were managed conservatively.
The mean primary patency rates at 1 year period were ranging from
62.5% to 25% (62.5% for forearm AVFs, 25% for upper arm AVFs, and
40% for grafts) (P<0.05). The secondary patency rates at 1 year were
ranging from 88% to 75% (88% for forearm AVFs. 75% for upper arm AVFs and 80% for grafts). Mean period necessary for reintervention was 14
months in the forearm. 5 months in the upper arm and 6.5 months in
grafts (P < 0.05). All patients are maintained on Aspirin and Coumarin.
Conclusion: The percutaneous treatment of stenosis and thrombosis
in hemodialysis access was effective in 90% of cases and yielded a mean
40% primary and 80% secondary patency rates at one year period. The
overall results were more encouraging in native forearm AVFs compared
to upper arm AVFs and grafts where maintenance of the two tatters need
more interventions. |
