Dialysis access venous stenosis: Treatment with balloon angioplasty 30‐second vs. 1‐minute inflation times

Abstract

Percutaneous balloon angioplasty is the standard of care in the endovascular treatment of dialysis access venous stenosis. The significance of balloon inflation times in the treatment of these stenoses is not well defined. Our objective was to examine the outcomes of 30-second vs. 1-minute balloon inflation times on primary-assisted patency of arteriovenous fistulae and grafts. Using a prospectively collected vascular access database, we identified a total of 75 patients referred for access dysfunction during a 5-year period. These patients received 223 interventions (178 with 30-second inflations and 45 with 1-minute inflations). We compared primary-assisted patency during the subsequent 9 months across groups defined by inflation times. Demographics and baseline characteristics were similar across groups. Immediate technical success and patency in the first 3 months were similar across groups (hazard ratio [HR] = 0.86; 95% confidence interval [CI]: 0.34-2.20). After 3 months, however, a 1-minute inflation time was associated with greater incidence of access failure (adjusted HR [aHR] = 1.74; 95% CI: 1.09-2.79). Other predictors of access failure included age over 60 (aHR = 1.02; 95% CI: 1.01-1.04), central location of the lesion (aHR = 2.49; CI: 1.27-4.89), and three or more prior procedures (aHR 2.48; CI: 1.19-5.16). Our data suggest that shorter balloon inflation times may be associated with improved longer term access patency, although the benefit was not observed until after 3 months. Given the increasing demands of maintaining access patency in the era of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative and Fistula First, the role of angioplasty times requires further study.

Results of repeated percutaneous interventions on failing arteriovenous fistulas and grafts and factors affecting outcomes

“…Technical success rates approaching 100% with low periprocedural complications are comparable to those reported for first-time percutaneous interventions. 5 Also, the poor primary patency observed in this study (32%) is comparable to that reported for primary percutaneous interventions, which ranges from 20% to 30%. 6,7 Our study demonstrates that additional reinterventions will be required, even after the second percutaneous intervention, to maintain arteriovenous access patency.…”

“…This improved secondary patency of AVFs in this study is not surprising as previous studies have documented superior longevity of AVFs compared with AVGs. 7 However, previous studies have identified the need for early PTA, age >60 years, diabetes, presence of a central lesion, and more than three previous procedures 3,5,9 as predictive of reduced patency of primary percutaneous interventions. We also had considered that a short time interval between the initial percutaneous intervention and the index procedure would predict ultimate access failure.…”

Does Technical Success of Angioplasty in Dysfunctional Hemodialysis Accesses Correlate with Access Patency?

“…It is plausible that if access patency was evaluated at 6 months or if a pooled access patency was assessed, as in our study, a significant impact on patency may have been observed. Balloon inflation times in the aforesaid study also ranged from 1 to 3 min, a potential confounder as longer inflation times have been suggested to negatively impact intermediate patency secondary to greater vessel trauma [16].…”

Balloon inflation time in angioplasty of dialysis access stenosis

“…In their recent observational study, Elramah et al reported that a 30-second balloon inflation was associated with longer primary-assisted patency compared with a 60second inflation in angioplasty of dialysis access stenosis. 1 Although the results are hypothesis generating, there are some important aspects of the study that warrant further discussion.…”

“…We were greatly interested to read the article entitled "Association of blood pressure with all-cause mortality and stroke in Japanese hemodialysis patients: The Japan dialysis outcomes and practice pattern study" by Inaba et al 1 Using data from the Japan Dialysis Outcomes and Practice Patterns Study (J-DOPPS), the authors revealed that both systolic and diastolic blood pressures were positively and monotonically associated with stroke-related death, suggesting that, as shown in the general population, hypertension is a definite risk factor for stroke-related death in hemodialysis patients. However, the DOPPS questionnaire did not distinguish between ischemic and hemorrhagic stroke.…”