Document Detail


Management of perianastomotic stenosis of direct wrist autogenous radial-cephalic arteriovenous accesses for dialysis.
MedLine Citation:
PMID:  20864300     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Radial-cephalic fistulas (RCFs) perianastomotic stenoses (PASs) are on and around the fistula anastomosis. This group of lesions encompasses juxta-anastomotic stenosis (stenosis located on the venous side within 3 cm away from the anastomosis), anastomotic, and arterial stenosis. The purpose of our study was to assess the postintervention primary patency and assisted postintervention primary patency (APP) rates for surgery and angioplasty when treating these stenoses. The secondary endpoint was to identify factors that might influence the procedure's patency rates.
MATERIALS AND METHODS: This retrospective study included 73 consecutive patients treated for lack of maturation PASs between January 1999 and December 2005 in two interventional centers. Patients' mean age was 65 years old. Stenoses were treated by surgery (n = 21) or percutaneous transluminal angioplasty (PTA; n = 52). Surgery meant creation of a new anastomosis excluding the area of stenosis. Preoperative characteristics including the patient's age, gender, comorbidities, stenosis location, and length were not statistically different between the two groups. The mean follow-up was 39 months for PTA and 49 months for surgery.
RESULTS: Anatomical and clinical success rates were 86% and 90% for surgery, and 75% and 92% for PTA. At 1 year, the primary patency rates were 71 ± 10% for surgery and 41 ± 6% for PTA, respectively (P < .02). There was no significant difference between the two groups with respect to assisted primary patency (95% vs 92%). In the PTA group, stenosis location at the anastomosis itself was a risk factor of early recurrence (P = .047). The complication rate was similar between surgery and PTA.
CONCLUSION: Our results suggest that the treatment of anastomotic stenoses should be surgical rather than endovascular. Angioplasty and surgery have shown similar results when used to treat other perianastomotic stenoses, but repeat procedures were more frequent with angioplasty.
Authors:
Bertrand Long; Nicolas Brichart; Patrick Lermusiaux; Luc Turmel-Rodrigues; Bernard Artru; Jean Michel Boutin; Josette Pengloan; Philippe Bertrand; Franck Bruyère
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study     Date:  2010-09-22
Journal Detail:
Title:  Journal of vascular surgery     Volume:  53     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-27     Completed Date:  2011-01-31     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:  108-14     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Service d'Urologie Hôpital Bretonneau, Tours, France.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty*
Arteriovenous Shunt, Surgical*
Constriction, Pathologic
Female
Graft Occlusion, Vascular / surgery,  therapy*
Humans
Kidney Failure, Chronic / therapy
Male
Middle Aged
Multivariate Analysis
Radial Artery / surgery
Recurrence
Retrospective Studies
Vascular Patency

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


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