Document Detail


Low-flow maturation failure of distal accesses: Treatment by angioplasty of forearm arteries.
MedLine Citation:
PMID:  19249186     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Forearm artery lesions are a frequent cause of distal fistula maturation failure. Surgical treatment is difficult because of highly calcified arteries. To redo the arteriovenous anastomosis higher up the forearm is technically difficult and often ineffective because arteries cannot be enlarged. It also causes a loss in puncture zone. Creation of brachial accesses leads to a high risk of distal ischemia.
METHODS: From September 2000 to September 2006, we performed percutaneous transluminal angioplasty (PTA) of forearm arteries in 25 patients with failing distal access maturation. We reported immediate results of the dilatation and retrospectively analyzed the outcome of the accesses after the procedure.
RESULTS: Forearm artery PTA was achieved in all 25 patients. Three main complications occurred: severe spasms precluding precise assessment of the artery patency after dilatation, rupture easily treated by prolonged low-pressure balloon inflation, and early rethrombosis leading to access loss. Follow-up was available in 23 patients. PTA failed to restore a sufficient access flow in two patients (the access loss and an insufficient increase in flow). In the remaining 21 (91%), accesses started to be used for hemodialysis without difficulties. Primary patency access rates after PTA were 83% (range, 60%-93%) at 1 year and 74% (range, 47%-89%) at 2 years. Secondary access patency rates were 86% (range, 64%-95%) at 1 and 3 years.
CONCLUSION: When a distal access fails to mature because of forearm artery lesions, PTA should be done and will salvage the fistula without risk of distal ischemia and cardiac failure. Efficacy of PTA clearly influences surgical strategy and is a major argument in favor of attempting to create distal accesses in patients with mild distal artery lesions. Even in cases of failure, such as early occlusion of the fistula, this technique does not jeopardize further proximal access creation. Forearm access creation should be avoided only in cases of extremely severe distal artery lesions.
Authors:
Alain Raynaud; Luigi Novelli; Pierre Bourquelot; Jan Stolba; Bernard Beyssen; Gilbert Franco
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Publication Detail:
Type:  Journal Article     Date:  2009-02-26
Journal Detail:
Title:  Journal of vascular surgery     Volume:  49     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-04-03     Completed Date:  2009-04-20     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  995-9     Citation Subset:  IM    
Affiliation:
Department of Cardiovascular and Interventional Radiology, Clinique Alleray Labrouste, Paris, France.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Angiography
Angioplasty, Balloon* / adverse effects
Arterial Occlusive Diseases / etiology
Arteriovenous Shunt, Surgical / adverse effects*
Brachiocephalic Veins / surgery
Female
Forearm / blood supply*
Humans
Male
Middle Aged
Radial Artery / injuries,  pathology,  physiopathology,  surgery*
Renal Dialysis*
Retrospective Studies
Rupture
Spasm / etiology
Thrombosis / etiology
Time Factors
Treatment Failure
Ulnar Artery / injuries,  pathology,  physiopathology,  surgery*
Ultrasonography, Doppler, Duplex
Vascular Patency

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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