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CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2021; 05(03): 142-149
DOI: 10.1055/s-0041-1728983
Original Article

Outcomes of Endovascular Therapy for Salvage of Hemodialysis Arteriovenous Fistulae

Nishtha Yadav
1   Department of Radiology, Super Speciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
,
Shivanand Gamanagatti
2   Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
,
Raju Sharma
2   Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
,
Sanjay Kumar Aggarwal
3   Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
,
V. K. Bansal
4   Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
,
Devasenathipathy Kandasamy
2   Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
,
V. Seenu
4   Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
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Abstract

Introduction Arteriovenous fistulae (AVF) for hemodialysis (HD) are prone to development of multiple complications, which can lead to nonfunctioning of the fistula. We report outcomes of endovascular management for dysfunctional HD AVF.

Materials and Methods In this prospective study, patients (43 men, 28 women, mean age 47.4 years) with clinical signs and symptoms of dysfunctional HD AVF and referred to interventional radiology for endovascular management were included. The most common clinical presentation included low flows during hemodialysis (n = 20), absent flow (n = 37), and failure of fistula maturation (n = 14). Patients with central venous obstruction who presented with limb swelling were excluded from this study. Patients underwent venography, venoplasty and thrombectomy, as appropriate, to salvage the fistula. The study outcomes were technical success, hemodynamic success, and clinical success of endovascular therapies in salvaging the fistulae.

Results The technical, hemodynamic and clinical success rates of endovascular therapy for low-flow symptoms were 95%, 70% and 95%, respectively. Among patients who presented with absent flow, endovascular therapy had 81% technical success, 78.3% hemodynamic success, and 81% clinical success. Endovascular therapy was associated with 64.2% technical success, 57.1% hemodynamic success, and 64.2% clinical success in patients presenting with failed maturation of the fistula. The overall clinical success rate was 58/71 (81.7%) and failure rate was 13/71 (18.3%). The overall complication rate of endovascular therapy was 8.4% and the complications included vein rupture in 5 (7%) and balloon rupture in 1 (1.4%).

Conclusion Endovascular therapy for salvage of nonfunctioning hemodialysis AVF is associated with a high-clinical success rate (81.7%) and low-complication rate.

Keywords

arteriovenous fistula - hemodialysis access - interventional radiology - balloon dilatation - venoplasty


Publikationsverlauf

Artikel online veröffentlicht:
01. Juni 2021

© 2021. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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