Background
Percutaneous transluminal angioplasty (PTA) is the mainstay of treatment in
stenosed hemodialysis access. Being less invasive and outpatient procedure,
PTA is a safe and useful intervention to maintain access patency in patients
with failing hemodialysis arteriovenous fistulas (AVFs). The aim of this study
was to evaluate the efficacy of balloon angioplasty in treatment of patients with
failing upper extremity hemodialysis access.
Methods
This is a prospective study of all adult patients who underwent balloon angioplasty
for the treatment of patients with symptoms of a failing dialysis access due to
presence of significant stenosis in dialysis access circuit. The study conducted at
the Department of Vascular and Endovascular Surgery, Assiut University Hospital
(a tertiary referral hospital), between January 2017 and December 2018. Both the
primary and assisted primary patency rates were analyzed by the Kaplan-Meier plot
method.
Results
149 patients underwent PTA for treatment of failing dialysis access symptoms. The
most common site of stenosis in our study was the juxta-anastomotic site (49 %).
The overall success rate was 96.6%. Balloon angioplasty was performed in all
patients without stent placement. Sixteen (10.7%) complications were encountered
in the study. At 1 year, the primary patency and the assisted primary patency rates
was 60.5% and 80%, respectively. Age of the fistula (P=0.017), presence of
multiple lesions (P=0.016), total lesion length >5cm (P=0.030), and diabetes
mellitus (P=0.012) were significant independent predictors of loss of primary
patency.
Conclusions
Balloon angioplasty is safe and effective treatment modality for treatment of
stenosis in failing hemodialysis access patients with good technical success and
acceptable short-term primary patency rates. Repeated interventions are required
to maintain patency.
Keywords:
failing hemodialysis access, percutaneous transluminal angioplasty, stenosis