Early Dysfunction of Radiocephalic Arteriovenous Fistula: Primary and Secondary Patency Rate of Percutaneous Angioplasty

Kim, Young Ok; Yoon, Sun Ae; Kim, Young Soo; Kim, Mi Kyoung; Oh, Hyun Jong; Ku, Young Mi; Song, Ha Hun; Kim, Ki Tae; Chang, Yoon Sik; Bang, Byung Kee

Abstract

BACKGROUND
The radiocephalic arteriovenous fistula (AVF), which provides the best vascular access for hemodialysis, continues to have a high incidence of early failure. This was studied to determine primary and secondary patency rate of percutaneous transluminal angioplasty (PTA) in hemodialysis patients who had early dysfunction of this AVF within 1 year after the operation. METHODS: This retrospective study enrolled 39 hemodialysis patients with early dysfunction of radiocephalic AVF who received PTA between January, 1997 and December, 2002 at Uijongbu St. Mary's Hospital. The lesions occurred at proximal vein of upper arm and central vein were excluded. The primary and secondary patency rate of PTA was evaluated using Kaplan-Meier method. According to diabetes, age, sex, onset of AVF dysfunction after the operation, thrombosis, patency rate was compared with log-rank test. RESULTS: The mean age of the patients was 54+/-13 years and the number of male was 16 (41.2%). Twenty-four patients (61.5%) had diabetes and Among 39 lesions observed at venography, there were 33 cases of stenosis and 6 cases of complete occlusion due to thrombosis. The onset of AVF dysfunction after the operation was 5.3+/-3.6 months and 11 cases developed before the first needling. Total PTAs were performed and initial success rate was 94.2% (n=49). Primary patency rate at 6, 12, 24, and 48 months was 74.8%, 55.8%, 55.8%, and 55.8%, respectively. Secondary patency rate at 6, 12, 24, 48 months was 89.7%, 86.1%, 81.8%, 81.8%. Diabetes, age, sex, onset of AVF dysfunction after the operation, thrombosis did not influenced primary patency rate of PTA. There was no PTA-related complication. CONCLUSION: Percutaneous transluminal angioplasty is considered to be effective and safe treatment for early dysfunction of radiocephalic arteriovenous fistula in hemodialysis patients.