Salvage of Nonmaturing Native Fistulas by Using Angioplasty

Clark, Timothy W.I.; Cohen, Raphael A.; Kwak, Andrew; Markmann, James F.; Stavropoulos, S. William; Patel, Aalpen A.; Soulen, Michael C.; Mondschein, Jeffrey I.; Kobrin, Sidney; Shlansky-Goldberg, Richard D.; Trerotola, Scott O.

doi:10.1148/radiol.2421051718

Cited by 104 publications

(82 citation statements)

References 20 publications

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“…The few published studies evaluating long term outcomes in AVFs requiring interventions to promote maturation reported cumulative survival rates of 68 to 82% at 1 year (19,20,35,36) and 62% at 2 years (35), similar to the rates observed in our investigation. Unfortunately, previous studies did not provide a comparison with a concurrent control group of AVFs not requiring such interventions.…”

Section: Discussionsupporting

confidence: 88%

Decreased Cumulative Access Survival in Arteriovenous Fistulas Requiring Interventions to Promote Maturation

Lee

Ullah

Allon

et al. 2011

Clinical Journal of the American Society of Nephrology

132

122

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SummaryBackground and objectives New arteriovenous fistulas (AVF) are frequently unsuitable for hemodialysis because of AVF nonmaturation. Aggressive endovascular or surgical interventions are often undertaken to salvage nonmaturing AVFs. The effect of early interventions to promote AVF maturation on subsequent long-term AVF outcomes is unknown.Design, setting, participants, & measurements We evaluated 173 hemodialysis patients from two academic centers who received a new AVF. Of these, 96 (56%) required no further intervention, 54 (31%) required one intervention, and 23 (13%) required two or more interventions to achieve suitability for dialysis. We calculated AVF survival and frequency of postmaturation interventions in each group.Results Cumulative AVF survival (access cannulation to permanent failure) in patients with two or more versus one versus zero interventions before maturation was 68% versus 78% versus 92% at 1 year, 57% versus 71% versus 85% at 2 years, and 42% versus 57% versus 75% at 3 years. Using Cox regression analysis with interventions before maturation, age, sex, race, diabetes, peripheral vascular disease, access site, and obesity in the model, intervention before maturation (two or more) was the only factor associated with cumulative AVF survival. The number of interventions required to maintain patency after maturation was 3.51 Ϯ 2.20 versus 1.37 Ϯ 0.31 versus 0.76 Ϯ 0.10 per year in patients with two or more versus one versus zero interventions before maturation. ConclusionsCompared with AVF that mature without interventions, AVF that require interventions have decreased cumulative survival and require more interventions to maintain their patency for hemodialysis.

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Section: Discussionsupporting

confidence: 88%

Decreased Cumulative Access Survival in Arteriovenous Fistulas Requiring Interventions to Promote Maturation

Lee

Ullah

Allon

et al. 2011

Clinical Journal of the American Society of Nephrology

132

122

View full text Add to dashboard Cite

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“…In this study 40.8% fistulae had multiple stenoses particularly located at the anastomotic and puncture area, similar to other data (7)(8)(9). Of note, our results showed a higher incidence of multiple lesions, although not statistically significant, on fistulae older than six months, particularly involving the puncture area and this finding is certainly related to venous punction (29).…”

Section: Discussionsupporting

confidence: 90%

Efficacy of Percutaneous Transluminal Angioplasty on Dysfunctional Fistulae Because of Inflow Stenosis

et al. 2013

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Purpose Autogenous fistulas are the preferential vascular access for hemodialysis. The aim of this retrospective study was to determine the efficacy of angioplasty for dysfunctional fistulas because of inflow dysfunction. Methods We reviewed all the angiographic procedures performed on our institution between April 2007 and April 2009. Procedures performed in dysfunctional fistulas because of inflow stenoses were analyzed. Fistulas with stenoses out of these areas were excluded. The following data were collected: patient age and sex, fistula age at the time of intervention, location of fistula, number and location of stenosis, angiography referral criteria, clinical findings (presence or absence of thrills, bruits and pulsatility) and date of reintervention or failure. Results During the study period 215 fistulas were submitted to angiography of which, seventy-one presented inflow stenosis (33%). Mean follow-up was 21.72±9.26 months, and average age was 7.03 months. Two groups were considered: 31 fistulas comprising ≤6 months old, and 40 fistulas >6 months old. Primary patency rates±SE for older fistulas at 6, 12, 18 and 24 months, respectively, was 91.3%± 0.04%, 80.7%± 0.07%, 53.8% ±0.10% and 34.2±0.1%. versus 91.7±0.08%, 57.1 ±0.14%, 23±0.14%, 11.4%± 0.1% for younger fistulas (P=0.04). Fistulas ≤6 months old and multiple stenosis were associated with a poorer primary patency rate (P=0.005). Conclusions Inflow stenosis is frequently associated with fistula dysfunction. In this study we only analyzed AVF with inflow stenosis and we have shown that angioplasty can have great patency results, particularly for single lesions in matured fistulas.

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“…Esses valores podem melhorar caso haja um sistema de avaliação pré-operatória no qual se consiga detectar vasos de pequeno calibre ou com estenoses naturais 6 . A taxa de falência para FAVH primária pode ser reduzida significativamente, como visto por Silva et al…”

Section: Discussionunclassified

“…A FAVH autógena, localizada na região do punho, tem sido a primeira escolha para a maioria dos cirurgiões, sendo que a FAVH rádio-cefálica originalmente descrita por Brescia & Cimino em 1966 ainda hoje é a que confere menor risco de complicações, além de apresentar boa durabilidade [4][5][6] .…”

Section: Introductionunclassified

Avaliação da maturação das fístulas arteriovenosas para hemodiálise pelo eco-Doppler colorido

et al. 2008

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ResumoContexto: Quando se confecciona uma fístula arteriovenosa para hemodiálise (FAVH) autógena, é necessário que se aguarde a dilatação da veia em questão e o desenvolvimento de volume de fluxo mínimo, fenômeno chamado de maturação. Ainda hoje se discute qual o tempo necessário para ocorrer essa maturação.Objetivo: Avaliar a maturação de FAVH utilizando-se critérios ecográficos. MHz para a avaliação no pré-operatório e nos 7º, 14º, 21º e 28º dias de pós-operatório. Os critérios para a maturação após a cirurgia foram: veia com diâmetro médio maior que 4 mm e volume de fluxo maior que 400 mL/min. Método Resultados:O diâmetro médio pré-operatório foi de 3,24±1,43 e 3,71±1,37 mm para fístulas de punho e de cotovelo, respectivamente. O diâmetro final foi de 5,01±0,87 mm para as FAVH de punho (p = 0,006) e de 6,15±1,16 mm para as FAVH de cotovelo (p = 0,95). O volume de fluxo no 7º dia pós-operatório foi de 493,63±257,49 mL/min e 976,33±332,90 mL/min para as FAVH de punho e cotovelo, respectivamente. Ao final do estudo, foi calculado o valor de 556,81±288,42 mL/min nas FAVH de punho (p < 0,05) e de 1031,62±614,812 mL/min nas FAVH de cotovelo. Baseados nos dois critérios, a maturação ocorreu em 57,1% das fístulas de punho e em 100% das fístulas de cotovelo após a 1ª semana. Após 4 semanas, 67,9% das fístulas de punho e 100% das fístulas de cotovelo apresentaram maturação. Conclusão:A maioria das FAVH de cotovelo apresentou diâmetro e fluxo adequados para punção logo após a 1ª semana de pós-operatório. Para as FAVH de punho, houve melhora progressiva dos padrões de maturação com o passar das semanas, sugerindo que essas FAVH devem ser puncionadas preferencialmente após a 4ª semana de pós-operatório.Palavras-chave: Fístula, arteriovenosa, hemodiálise, eco-Doppler colorido. AbstractBackground: When a hemodialysis arteriovenous fistula (HAVF) is created, it is important to wait for venous dilatation and volume flow increase through the HAVF, a phenomenon called maturation. There is still some controversy as to the exact time required for this maturation to occur.

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Salvage of Nonmaturing Native Fistulas by Using Angioplasty

Abstract: Early fistulography enables identification of underlying areas of stenosis in nonmaturing fistulas, which can be safely and effectively treated with angioplasty. With continued surveillance and repeat interventions, functional patency can be sustained in the majority of fistulas.

Cited by 104 publications

References 20 publications

Decreased Cumulative Access Survival in Arteriovenous Fistulas Requiring Interventions to Promote Maturation

Decreased Cumulative Access Survival in Arteriovenous Fistulas Requiring Interventions to Promote Maturation

Efficacy of Percutaneous Transluminal Angioplasty on Dysfunctional Fistulae Because of Inflow Stenosis

Avaliação da maturação das fístulas arteriovenosas para hemodiálise pelo eco-Doppler colorido

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