| Primary balloon angioplasty of small (≤2 mm) cephalic veins improves primary patency of arteriovenous fistulae and decreases reintervention rates. | |
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MedLine Citation:
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PMID: 23153423 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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PURPOSE: The purpose of this study was to evaluate the effect of primary balloon angioplasty (PBA) of cephalic veins with diameter ≤2 mm on patency and maturation time of autogenous radiocephalic arteriovenous fistulae (AVF) for hemodialysis. METHODS: Forty patients, all candidates for distal AVF, with a cephalic vein ≤2 mm, were randomized to two different surgical procedures: (1) PBA of a long segment of the cephalic vein from the wrist up to the elbow (n = 19); and (2) hydrostatic dilatation (HD) of a short venous segment (5 cm) at the level of the anastomosis (n = 21). PBA was performed using a standard balloon 4 × 150 mm. Primary end points were primary patency and reintervention rates. Secondary end points were maturation time and the rate of working AVF. Follow-up included physical and duplex ultrasound (DUS) examinations at 1,4, and 8 weeks, and every 3 months thereafter. RESULTS: Risk factors were homogeneously distributed between the two groups. Mean vein diameter was 1.8 ± 0.2 mm for the PBA group and 1.7 ± 0.2 mm for HD. Immediate success rate was 100% for PBA and 67% for HD groups (P = .04). Causes of failure in the HD group included early vein thrombosis in seven patients (33%). Mean fistula maturation time was 32 days in the PBA group and 55 days in the HD group (P = .04). During the mean follow-up of 7 months, three patients underwent drug-eluting balloon angioplasty for failure of AVF to mature due to stenosis (1 in the PBA group and 2 in the HD group). Six-month reintervention rate was significantly lower in the PBA group (5%) compared with the HD group (43%) (P = .02). At 6 months, primary patency rates were 95% in the PBA group and 57% in the HD group (P = .01). Working AVF rate was 100% in the PBA vs 90% in the HD group. CONCLUSIONS: PBA of very small cephalic veins during the creation of a distal AVF for hemodialysis is a safe and feasible procedure. This technique assures excellent primary patency, maturation time, and dramatically decreases reintervention rate. |
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Authors:
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Pierfrancesco Veroux; Alessia Giaquinta; Tiziano Tallarita; Nunziata Sinagra; Carla Virgilio; Domenico Zerbo; Peter Gloviczki; Massimiliano Veroux |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-11-13 |
Journal Detail:
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Title: Journal of vascular surgery Volume: - ISSN: 1097-6809 ISO Abbreviation: J. Vasc. Surg. Publication Date: 2012 Nov |
Date Detail:
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Created Date: 2012-11-16 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8407742 Medline TA: J Vasc Surg Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved. |
Affiliation:
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Vascular Surgery and Organ Transplant Unit, Department of Surgery, Transplantation and Advanced Technologies, University Hospital of Catania, Catania, Italy. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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