Safety and efficacy of arteriovenous fistula angioplasties performed by nephrologists: report from a Brazilian interventional nephrology center

Abstract

Introduction: Arteriovenous fistulas (AVF) are the first choice vascular access for hemodialysis. However, they present a high incidence of venous stenosis leading to thrombosis. Although training in interventional nephrology may improve accessibility for treatment of venous stenosis, there is limited data on the safety and efficacy of this approach performed by trained nephrologists in low-income and developing countries. Methods: This study presents the retrospective results of AVF angioplasties performed by trained nephrologists in a Brazilian outpatient interventional nephrology center. The primary outcome was technical success rate (completion of the procedure with angioplasty of all stenoses) and secondary outcomes were complication rates and overall AVF patency. Findings: Two hundred fifty-six angioplasties were performed in 160 AVF. The technical success rate was 88.77% and the main cause of technical failure was venous occlusion (10%). The incidence of complications was 13.67%, with only one patient needing hospitalization and four accesses lost due to the presence of hematomas and/or thrombosis. Grade 1 hematomas were the most frequent complication (8.2%). The overall patency found was 88.2 and 80.9% at 180 and 360 days after the procedure, respectively. Conclusion: Our findings suggest that AVF angioplasty performed by trained nephrologists has acceptable success rates and patency, with a low incidence of major complications as well as a low need for hospitalization.

Health insurance provider and endovascular treatment availability are associated with different hemodialysis vascular access profiles: A Brazilian national survey

“…Moreover, inferior access to adequate infrastructure, such as ultrasound machines and fluoroscopy suites, and the low training opportunities for nephrologists and surgeons exacerbate the problem. Despite these barriers, TC prevalence has increased over the years, which may be explained by the increasing interventional nephrology and HD vascular access training in the country (16,17). In our survey, nephrologists were involved in TC catheter procedures in almost half the centers; however, their participation in endovascular procedures was very low (3 out of 47 centers), probably because of the limited access to endovascular suites and training.…”

“…Such long periods of wait are not practical for HD patients, as many develop thrombosis and require a catheter until a new AV access is created. Most vascular access thrombosis is due to stenosis, which can be treated with angioplasty without disrupting the dialysis schedule of the patient (16,17,(29)(30)(31). In the USA, the outpatient treatment of dysfunctional vascular access in specialized centers is a consolidated reality, with published results (32)(33)(34)(35).…”