The Effect of Massaging on Hemodialysis Shunt Occlusion

Shin, Ho Sik; Jung, Yeon Soon; Rim, Hark

Abstract

BACKGROUND
The purpose of this study was to evaluate the effect of massaging and to determine patency rates and factors affecting the long term patency rates in the management of insufficient arteriovenous fistula (AVF). METHODS: We retrospectively investigated medical records of total 26 dialysis patients who had insufficient AVF. 26 cases of insufficient dialysis shunts in 26 patients were directed massaging. These patients' clinical characteristics and patency rates were evaluated. Depending on the patient's age and sex, history of diabetes mellitus, type and age of the AVF, occluded site of AVF, presence of graft, presence of percutaneous transluminal angioplasty (PTA), duration of patent AVF from AVF operation to 1st hemodialysis, duration of patent AVF from 1st hemodialysis to massage, and duration of detection by clinician after AVF insufficiency, patency rates were compared within each subgroup using Kaplan-Meier log rank test. RESULTS: Initial success rate was 84.6% (22/26 cases). For the mean follow-up observation duration of 19.8+/-17.0 months (0-48 months), 8 out of the 22 cases of reopened AVF by massaging were in patent AVF state without additional procedure. Out of the same 22 cases, PTA were performed in 6 cases and among these 6 cases, 4 cases were in patent AVF state for the mean follow-up observation duration. Among the 7 cases of early AVF insufficiency, 6 cases succeeded in massaging. The mean duration of patent AVF after massaging was 21.1+/-15.8 months (0.1-48 months). In cases in which initial success was obtained, the primary patency rates at 6, 12, 24, and 48 months after massaging were 81.2, 67.7, 54.1, 54.1%, respectively. The secondary patency rates at the same point of time were 100.0, 80.0, 80.0, 53.3%, respectively. The effect of the above mentioned factors on long-term patency was not statistically significant (p>0.05). There were no massaging- related complications. CONCLUSION: Massaging is considered to be an effective, safe and triable treatment modality for AVF insufficiency.