Document Detail

Salvage of nonmaturing native fistulas by using angioplasty.
MedLine Citation:
PMID:  17090715     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To retrospectively review outcomes following angioplasty of nonmaturing autogenous hemodialysis fistulas. MATERIALS AND METHODS: Institutional review board exemption was received for this HIPAA-compliant retrospective study; informed consent was waived. During 48 months, 101 patients underwent fistulography for percutaneous salvage of nonmaturing native fistulas. Clinical and technical success, need for secondary interventions, and complications were recorded according to consensus definitions. Patency following angioplasty was estimated with the Kaplan-Meier technique. Patient age, sex, ethnicity, fistula age, fistula type, number of stenoses, maximal angioplastic balloon diameter used, and presence of palpable thrill following angioplasty were examined as predictors of primary patency of the fistula following intervention by using Cox proportional hazards model. RESULTS: Mean patient age was 58 years; 35% were women. Median time from fistula creation to fistulography was 2.5 months. Hemodynamically significant (>50%) stenoses were identified in 88% (89 of 101) of patients; angioplasty was attempted in 96% (85 of 89). Technical success was achieved in 92% (78 of 85) of fistulas following angioplasty; clinical success of normal hemodialysis with total access blood flow of more than 500 mL/min occurred following 88% (75 of 85) of angioplastic interventions. No major and two minor complications occurred. Mean primary unassisted patency at 3, 6, and 12 months was 60%+/-6% (95% confidence interval), 45%+/-6%, and 34%+/-6%, respectively. Additional angioplasty (n=12), stent placement (n=1), or thrombectomy (n=1) during subsequent interventions resulted in mean secondary patency at 3, 6, and 12 months of 82%+/-4%, 79%+/-5%, and 75%+/-6%, respectively. Patients without thrill following angioplasty were more than twice as likely to lose patency as patients with thrill (P=.035). No relationship was seen between primary patency and other predictors examined. CONCLUSION: 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.
Timothy W I Clark; Raphael A Cohen; Andrew Kwak; James F Markmann; S William Stavropoulos; Aalpen A Patel; Michael C Soulen; Jeffrey I Mondschein; Sidney Kobrin; Richard D Shlansky-Goldberg; Scott O Trerotola
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Publication Detail:
Type:  Journal Article     Date:  2006-11-07
Journal Detail:
Title:  Radiology     Volume:  242     ISSN:  0033-8419     ISO Abbreviation:  Radiology     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2006-12-22     Completed Date:  2007-02-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0401260     Medline TA:  Radiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  286-92     Citation Subset:  AIM; IM    
Copyright Information:
Copyright (c) RSNA, 2006.
Department of Radiology, Division of Interventional Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
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MeSH Terms
Angioplasty / methods*
Fistula / etiology*,  radiography,  surgery*
Middle Aged
Renal Dialysis / adverse effects*
Retrospective Studies
Salvage Therapy / methods*
Treatment Outcome

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