J Korean Radiol Soc.  2003 Jan;48(1):29-37. 10.3348/jkrs.2003.48.1.29.

Percutaneous Intervention for Permanent Hemodialysis Access

• Kim JH
• Do YS
• Shin SW
• Choo SW
• Liu WC
• Huh WS
• Oh HY
• Kim DI
• Choo IW
• Buyn HS

• KMID: 2103699
• DOI: http://doi.org/10.3348/jkrs.2003.48.1.29

Abstract

PURPOSE: To evaluate the effectiveness of percutaneous transluminal angioplasty (PTA) and pulse-spray pharmacomechanical thrombolysis (PSPMT) using urokinase for the management of insufficient hemodyalitic access, and to identify contributory patency-related factors following interventional procedures.
MATERIALS AND METHODS
Between August 1995 and July 2001, 105 cases of insufficient hemodyalitic access involving 38 artificial arteriovenous fistulae (AVF) and 67 graft arteriovenous fistulae (AVG) were treated interventionally. The patients underwent PTA alone in 53 cases and PSPMT combined with PTA in 47, and procedural success and long-term patency were evaluated in terms of a patient's age and sex, the presence of diabetes, the location of access, the type of AVG, the draining vein of AVG, the presence of central vein stenosis, the degree of residual stenosis, and the method of interventional procedure, and contributory factors were thus identified.
RESULTS
The overall technical success rate of interventional management was 83.8% (88/105), while the overall primary patency rate was 58.7+/-5.2% at 6 months, 43.0+/-6.0% at 1 year, and 18.1+/-6.0% at 2 years. In AVF/AVG groups, primary patency rates were 55.9+/-9.2%/57.8+/-6.5% at 6 months, 45.8+/-10.0%/42.7+/-8.4% at 1 year, and 21.8%+/-9.8%/18.9+/-6.5% at 2 years. The overall secondary patency rate was 40.0+/-8.1% at 2 years. No contributory factors were found (95% confidence level), though patency of access decreased when residual stenosis was more than 30% (p=0.054).
CONCLUSION
Interventional management of insufficient hemodyalitic access has high success and patency rates, and is an effective primary method. There appear to be no contributory factors, though residual stenosis of more than 30% tends to decrease the patency of hemodialytic access.

Keyword

Fistula, arteriovenous; Graft arteriovenous fistula; Transluminal angioplasty; Thrombolysis

MeSH Terms

Angioplasty
Arteriovenous Fistula
Constriction, Pathologic
Humans
Renal Dialysis*
Transplants
Urokinase-Type Plasminogen Activator
Veins
Urokinase-Type Plasminogen Activator