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Dysfunctional Autogenous Hemodialysis Fistulas: Outcomes after Angioplasty—Are There Clinical Predictors of Patency?¹

¹ From the Department of Medical Imaging, Division of Vascular and Interventional Radiology (D.K.R.), Clinical Studies Resources Centre (R.P.), and Department of Nephrology (C.E.L.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, NCSB 1C-553, Toronto, ON, Canada M5G 2N2; Department of Radiology, Dalhousie Medical School, Halifax, Nova Scotia, Canada (S.B.); and Department of Radiology, Mayo Clinic, Rochester, Minn (S.M.). From the 2003 RSNA scientific assembly. Received May 8, 2003; revision requested July 16; final revision received November 24; accepted January 2, 2004. Address correspondence to D.K.R. (e-mail: dheeraj.rajan@uhn.on.ca).

PURPOSE: To determine the primary and secondary patency rates for fistulas treated with angioplasty, as well as clinical predictors of fistula patency after angioplasty.

MATERIALS AND METHODS: The authors reviewed their institutional experience with autogenous fistulas from June 1997 to June 2002. A total of 104 men and 36 women were treated. Mean age ± standard deviation of patient cohort was 62.4 years ± 15.6. Patient age and sex, age of fistula at initial intervention, presence of diabetes, side and location of fistula, location of stenosis, and number of venous stenoses dilated were examined. Patency after angioplasty was estimated by using the Kaplan-Meier method, and predictors of patency were examined by using a Cox proportional hazards model.

RESULTS: One hundred fifty-one dysfunctional fistulas (94 radiocephalic and 57 brachiocephalic) were treated with angioplasty initially. Clinical success rate was 98.0% (297 of 303 interventions). At 3, 6, and 12 months, respectively, primary patency rates ± standard errors of the estimate were 73% ± 6, 51% ± 7, and 39% ± 7 for brachiocephalic fistulas and 85% ± 4, 75% ± 5, and 62% ± 5 for radiocephalic fistulas; secondary patency rates were 96% ± 2.4, 89% ± 4, and 85% ± 5 for brachiocephalic fistulas and 91% ± 3, 88% ± 3, and 86% ± 4 for radiocephalic fistulas. For all time points, there was a significant difference in primary (P = .004) but not secondary (P = .45) patency between radiocephalic and brachiocephalic fistulas. Stenosis was most prevalent within 3 cm of the arteriovenous anastomosis in 74 (64%) of the 116 dysfunctional radiocephalic fistulas and at the cephalic arch in 22 (30%) of the 74 dysfunctional brachiocephalic fistulas. The clinical variables examined did not influence outcome. Complications occurred in seven (2.3%) of 303 interventions.

CONCLUSION: Patency after angioplasty in dysfunctional autogenous hemodialysis fistulas exceeds that observed in hemodialysis grafts. None of the clinical or anatomic variables examined affected patency outcome.

© RSNA, 2004

Index terms: Dialysis, shunts • Fistula, arteriovenous • Veins, transluminal angioplasty, 916.1282

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