Impact of Lesion Morphology on Durability After Angioplasty of Failed Arteriovenous Fistulas in Hemodialysis Patients

Suemitsu, Kotaro; Shiraki, Tatsuya; Iida, Osamu; Kobayashi, Hiroki; Matsuoka, Yuki; Izumi, Masayuki; Nakanishi, Takeshi

doi:10.1177/1526602817748316

Cited by 16 publications

(26 citation statements)

References 19 publications

(22 reference statements)

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“…VA, vascular access; DSA, digital angiography; PTA, percutaneous transluminal angioplasty. (7,16,17).…”

Section: Multivariate Analysismentioning

confidence: 99%

“…PTA can restore the flow of occluded vascular vessels, with a success rate of 80-100% (5). And it is an established treatment for stenosis in both AVFs and AVGs, which can significantly extend the patency duration of fistulas (6,7). However, as a result of recurrent stenosis, repeated interventions have often been required, with a reported average of 3.1-3.5 times before access is ultimately abandoned (5,6).…”

Section: Introductionmentioning

confidence: 99%

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Predictors associated with early and late restenosis of arteriovenous fistulas and grafts after percutaneous transluminal angiography

Zheng¹,

Xie²,

Xie³

et al. 2021

Ann Transl Med

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Background: The objective of this study was to assess postintervention patency and analyze the predictive factors associated with early and late restenosis after intervention in hemodialysis arteriovenous fistulas (AVF) and arteriovenous grafts (AVG).Methods: This study retrospectively analyzed 284 hemodialysis patients who underwent percutaneous transluminal angioplasty (PTA) due to AVF and AVG stenosis. A total of 350 PTA procedures were performed. Clinical, anatomical, biochemical, and technical variables were analyzed. Using univariate and multivariate analyses, we assessed the postintervention patency of PTA by follow-up, and identified the predictive factors taking into account competing risks.Results: Postintervention patency rates at 3, 6, 12, and 24 months were 86.5%, 66.4%, 42.6%, and 29.8%, respectively, with a median patency duration of 11±0.71 months. Kaplan-Meier analysis showed that the patency rate of the AVF group (n=271) was dramatically higher than the AVG group (n=79) at 3, 6, and 12 months after PTA, respectively (88.9% vs. 78.5%, 69.0% vs. 57.4%, 48.8% vs. 20.0%, P<0.01). Cox survival analysis revealed that the factors associated with postintervention patency of AVF included age of fistulas, serum albumin (ALB) levels, location of stenoses, lesion length longer than 2 cm, multiple stenoses, and maximal pressure of dilatation lower than 16 atm. In addition, factors related to postintervention patency of AVG included the presence of diabetes and hypertension, and serum ALB.Conclusions: This study demonstrated that the risk factors associated with postintervention patency of AVF included age of fistulas, lower levels of serum ALB, location of stenoses, lesion length longer than 2 cm, multiple stenoses, and maximal pressure of dilatation lower than 16 atm. In addition, risk factors related to postintervention patency of AVG included the presence of diabetes and lower levels of serum ALB, while the presence of hypertension was found to be a protective factor for reducing patency loss of AVG. Among all these factors, serum ALB and multiple stenoses tended to predict early restenosis, while pressure of dilatation tended to predict late restenosis.

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“…VA, vascular access; DSA, digital angiography; PTA, percutaneous transluminal angioplasty. (7,16,17).…”

Section: Multivariate Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predictors associated with early and late restenosis of arteriovenous fistulas and grafts after percutaneous transluminal angiography

Zheng¹,

Xie²,

Xie³

et al. 2021

Ann Transl Med

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show abstract

“…Suemitsu et al in 2017 described three types of stenosis based on ultrasound appearances; an intimal hyperplasia type, a shrinking type and a valve type. They reported that a shrinking lumen morphology had a negative impact on primary patency at 6 months following percutaneous angioplasty (HR 2.05, 95% CI 1.25–3.36, p = 0.005) and a venous valve type stenosis had a positive impact on primary patency (HR 0.19, 95% CI 0.04–0.79, p = 0.023) 9 . Both these studies suggest that the type of AVF stenosis assessed on ultrasound may affect patency rates after treatment.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound appearances and histological correlation of native arteriovenous fistula stenoses – A retrospective case series

Steiner

Ramanarayanan

Metcalfe

et al. 2021

Seminars in Dialysis

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Failure of maturation of native autologous arteriovenous fistulae (AVFs), fistula thrombosis and dialysis access dysfunction are most often caused by arteriovenous (AV) access stenosis. 1 The pathophysiology of AVF stenosis and mechanisms of restenosis are not yet fully understood.Venous neointimal hyperplasia is a recognised cause of vascular access stenosis and fistula failure. 2 Failure of fistula maturation and early fistula failure have been shown to be due to both neointimal hyperplasia and adverse adventitial remodelling or a failure of venous dilatation resulting in AVF stenosis. 2 Ultrasound is a non-invasive, readily available diagnostic tool used in the assessment of AVF dysfunction and failure of fistula maturation. Doppler ultrasound has a high sensitivity and specificity in the diagnosis of vascular access stenosis. 3,4 The technique, in the hands of an experienced operator, has high accuracy and reproducibility in detecting more than 90% of significant stenosis. 4 Ultrasound can also be used to assess neointimal hyperplasia by measuring intimal-medial thickness (IMT) at the site of a stenosis. 5 Carotid intima-media thickness (CIMT) measurements are made

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“…Yamamoto et al [17] described a cohort of 46 AVG outflow stenosis cases whose lesions were divided into 3 groups by DU evaluation: vascular constriction types (13/46, 28.3%), neointimal proliferation types (12/46, 26.1%), and mixed types (21/46, 45.7%); the vascular constriction type in their study displayed excellent primary patency rates after stent treatment. Suemitsu et al [18] investigated 158 AVF venous lesions and divided them into 3 stenosis patterns by ultrasonography: intimal hyperplasia stenosis (110/158, 69.6%), shrinking lumen stenosis (32/158, 20.3%), and venous valve-related stenosis (16/158, 10.1%). In their analysis, the AVF stenosis pattern affected the outcome after PTA; the shrinking lumen morphology had a negative impact on primary patency (HR 2.05, 95% CI 1.25–3.36, and p = 0.005), while the venous valve-related stenosis had a positive impact (HR 0.19, 95% CI 0.04–0.79, and p = 0.023).…”

Section: Discussionmentioning

confidence: 99%

Morphological Lesion Types Are Associated with Primary and Secondary Patency Rates after High-Pressure Balloon Angioplasty for Dysfunctional Arteriovenous Fistulas

et al. 2021

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Background: Neointimal hyperplasia (NIH) is believed to be the main reason for arteriovenous fistula (AVF) dysfunction, but other mechanisms are also recognized to be involved in the pathophysiological process. This study investigated whether different morphological types of AVF lesions are associated with the patency rate after percutaneous transluminal angioplasty (PTA). Methods: This retrospective study included 120 patients who underwent PTA for autogenous AVF dysfunction. All the cases were evaluated under Doppler ultrasound (DU) before intervention and divided into 3 types: Type I (NIH type), Type II (non-NIH type), and Type III (mixed type). Prognostic and clinical data were analyzed by Kaplan-Meier analysis and the Cox proportional hazards model. Results: There was no statistical difference in baseline variables among groups, except for lumen diameter. The primary patency rates in Type I, Type II, and Type III groups were 78.4, 93.2, and 83.2% at 6 months and 59.5, 84.7, and 75.5% at 1 year, respectively. The secondary patency rates in Type I, Type II, and Type III groups were 94.4, 97.1, and 100% at 6 months and 90.5, 97.1, and 94.7% at 1 year, respectively. The Kaplan-Meier curve showed that the primary and secondary patency rates of Type I group were lower than those of Type II group. Multivariable Cox regression analysis demonstrated that postoperative primary patency was correlated with end-to-end anastomosis (hazard ratio [HR] = 2.997, p = 0.008, 95% confidence interval [CI]: 1.328–6.764) and Type I lesion (HR = 5.395, p = 0.004, 95% CI: 1.730–16.824). Conclusions: NIH-dominant lesions of AVF evaluated by DU preoperatively were a risk factor for poor primary and secondary patency rate after PTA in hemodialysis patients.

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Impact of Lesion Morphology on Durability After Angioplasty of Failed Arteriovenous Fistulas in Hemodialysis Patients

Abstract: The patterns of AVF stenosis as determined by ultrasound can affect the outcome of treatment with balloon dilation.

Cited by 16 publications

References 19 publications

Predictors associated with early and late restenosis of arteriovenous fistulas and grafts after percutaneous transluminal angiography

Predictors associated with early and late restenosis of arteriovenous fistulas and grafts after percutaneous transluminal angiography

Ultrasound appearances and histological correlation of native arteriovenous fistula stenoses – A retrospective case series

Morphological Lesion Types Are Associated with Primary and Secondary Patency Rates after High-Pressure Balloon Angioplasty for Dysfunctional Arteriovenous Fistulas

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