ORIGINAL ARTICLE
Year : 2015  |  Volume : 2  |  Issue : 1  |  Page : 7-11

Predictors of Patency Following Fistulography and Percutaneous Interventions in the Treatment of Nonfunctioning Native Vascular Access


Department of Surgery, St. John's Medical College, Bengaluru, Karnataka, India

Correspondence Address:
Dr. Brendan Hermenigildo Dias
Department of Surgery, St. John's Medical College, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-0820.152824

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Aim: The aim was to evaluate the various factors predicting patency following fistulography and percutaneous interventions in the management of nonfunctioning native vascular access. Materials and Methods: Retrospective analysis of 61 patients with native arteriovenous fistulae (AVF) who underwent fistulography and percutaneous interventions from January 2010 to December 2013. Mean patient age was 47 (23-78) years. 69% (42 of 61) of the patients were males. 56% (34 of 61) of patients underwent elbow AVF creation, and the remaining were forearm AVFs. Median time from fistula creation to fistulography was 9 months. On fistulography, hemodynamically significant (>50%) stenosis were identified in 93% (57 of 61) of patients. Angioplasty was attempted in 88% (54 of 57) of fistulae. In 14% (8 of 54) of cases, stent was placed. Results: Technical success was achieved in 98% (53 of 54) of fistulae following angioplasty. Clinical success (ability to use the AVF for successful hemodialysis) was noted in 87% (47 of 54) of cases. About 52% (32 of 61) of the fistulae had multiple stenosis. The most common location of stenosis was the venous limb of the fistula (70%). The primary patency rates were 75.4%, 68.9%, and 30% at 3, 6 and 12 months. The secondary patency rates were 100%, 89%, and 70% at 3, 6 and 12 months. The absence of palpable thrill postprocedure was found to be a risk factor for both primary, as well as secondary patency rates. Conclusions: Our results demonstrate that fistulography and percutaneous interventions in the form of angioplasty and stenting are helpful in maintaining the patency of nonfunctioning native vascular access. We found that the most important predictor of fistula patency following percutaneous interventions is the presence of palpable thrill. Our study also showed that stent placement is effective in treating venous stenotic lesions in native arteriovenous fistula hemodialysis patients after unsatisfactory balloon dilatation.


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