Document Detail


Ultrasound-guided angioplasty of autogenous arteriovenous fistulas in the office setting.
MedLine Citation:
PMID:  22265799     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: There has been an increasing awareness of the superiority of native arteriovenous fistulas (AVFs) over prosthetic grafts for dialysis access. Many AVFs fail to mature, however, and others develop stenosis while in use. There is growing experience in treating these patients in the interventional suite with percutaneous balloon angioplasty. These procedures, however, are expensive, uncomfortable, and inconvenient for patients and physicians, and involve exposure to radiation and intravenous contrast in patients who are often not on dialysis. This study reviews our experience with ultrasound-guided angioplasty of AVFs in the office setting.
METHODS: A retrospective review was performed of all patients treated in our practice with ultrasound-guided AVF angioplasty, from May 2009 to April 2011. The need for intervention was determined by examination and duplex ultrasound. All patients referred to the practice with failing or nonmaturing AVFs were treated in the office under ultrasound guidance, unless a central venous stenosis was suspected. All procedures were performed with the patient under local anesthesia by a single surgeon, and preprocedure, periprocedure, and postprocedure ultrasounds were performed in a single vascular laboratory.
RESULTS: There were 31 AVFs in 30 patients in the study. Fifty-five interventions were performed, 48 for AVFs failing to mature and seven for stenosis in functioning AFVs. The 90-day patency was 93%. The overall complication rate was 11%. Two patients had proximal stenosis that could not be crossed (one patient required surgical revision and one patient refused further treatment and thrombosed). There were four perifistular hematomas; three of these resulted in AFV thrombosis. No patients required hospitalization or urgent surgical intervention. Eighty-five percent of patients treated for AVF failing to mature achieved a functional fistula.
CONCLUSIONS: AVF intervention can be performed safely and effectively under ultrasound guidance in the office setting and is a valuable tool in the management of dialysis access patients.
Authors:
Daniel R Gorin; Lisa Perrino; Donna M Potter; Tarik Z Ali
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Publication Detail:
Type:  Journal Article     Date:  2012-01-23
Journal Detail:
Title:  Journal of vascular surgery     Volume:  55     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-05-21     Completed Date:  2012-07-18     Revised Date:  2012-12-17    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1701-5     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Southeastern Surgical Associates, Department of Surgery, Cape Cod Hospital, Hyannis, MA 02601, USA. dgorin@sesurgery.com
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MeSH Terms
Descriptor/Qualifier:
Anesthesia, Local
Angioplasty, Balloon* / adverse effects
Arteriovenous Shunt, Surgical / adverse effects*
Constriction, Pathologic
Graft Occlusion, Vascular / etiology,  physiopathology,  therapy*,  ultrasonography
Humans
Office Visits*
Renal Dialysis*
Retrospective Studies
Time Factors
Treatment Outcome
Ultrasonography, Doppler, Duplex*
Ultrasonography, Interventional / methods*
Vascular Patency
Comments/Corrections
Erratum In:
J Vasc Surg. 2012 Nov;56(5):1488

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


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