J Korean Soc Radiol.  2019 May;80(3):477-489. 10.3348/jksr.2019.80.3.477.

Effectiveness and Influencing Factors of Percutaneous Transluminal Angioplasty for Stenosis of Transposed Brachiobasilic Arteriovenous Fistula

• Shin D
• Kim YJ
• Yang SB
• Lee JM
• Lee WH
• Goo DE

• KMID: 2454027
• DOI: http://doi.org/10.3348/jksr.2019.80.3.477

Abstract

PURPOSE
To evaluate effectiveness of percutaneous transluminal angioplasty (PTA) for transposed brachiobasilic arteriovenous fistula (tBBAVF), and to analyze the factors influencing patency after PTA.
MATERIALS AND METHODS
In 101 patients who underwent operation for tBBAVF from January 2006 to February 2008, we identified 42 patients undergoing PTA. We conducted a retrospective analysis of sequential PTAs in these patients from 2006 to 2017.
RESULTS
A total of 100 PTAs were performed. The technical success rate was 93% and the clinical success was 100%. Only ruptures occurred in 12% as minor complications. Primary patency rate was 61%, 29%, 7%, and secondary patency was 91%, 82%, 59% at 6, 12, and 24 months, respectively. Primary patency rate was lower in tBBAVF with rupture (p = 0.024). Secondary patency rate was significantly lower in the diabetes (p = 0.002).
CONCLUSION
Repetitive PTAs in tBBAVF are acceptable due to excellent secondary patency. Primary patency of tBBAVF is low in patients with rupture. Diabetes itself has a significant effect on secondary patency.

MeSH Terms

Angioplasty*
Arteriovenous Fistula*
Constriction, Pathologic*
Diabetes Mellitus
Humans
Retrospective Studies
Rupture
Vascular Patency

Figure

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  Fig. 1 Distribution of stenoses among all stenotic sites (n = 142).

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  Fig. 2 A 64-year-old man with technically successful percutaneous transluminal angioplasty. A. Preprocedural fistulogram shows severe juxta-anastomotic stenosis in transposed brachiobasilic arteriovenous fistula. Stenotic site (arrow). B. A 6 mm × 80 mm balloon was used to treat this lesion. C. Stenosis was completely resolved after angioplasty without complication. Stenotic site (arrow).

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  Fig. 3 A 63-year-old woman who underwent a technically failed but clinically successful percutaneous transluminal angioplasty. A. Preprocedural angiogram shows stenosis in the axillary vein in transposed brachiobasilic arteriovenous fistula. Stenotic site (arrow). B. A 5 mm × 20 mm cutting balloon was used to treat this lesion. C. Roadmap image after ballooning shows residual stenosis of about 50%. Stenotic site (arrow).

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  Fig. 4 Kaplan-Meier curves of postintervention primary and secondary patency for transposed brachiobasilic arteriovenous fistula.

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  Fig. 5 Postintervention primary patency for transposed brachiobasilic arteriovenous fistula with angioplasty-induced rupture and non-rupture (p = 0.024).

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  Fig. 6 Postintervention secondary patency for transposed brachiobasilic arteriovenous fistula with diabetes (p = 0.04). DM = diabetes mellitus.

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  Fig. 7 Postintervention primary patency according to location of stenotic site. Central vein stenosis showed borderline significant lower postintervention primary patency when compared with other stenotic sites in patients with a single stenotic site in transposed brachiobasilic arteriovenous fistula (hazard ratio, 15.267; 95% confidence interval, 0.962 to 242.389; p = 0.053).

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