Percutaneous maintenance and salvage of dysfunctional arteriovenous fistulae and grafts by nephrologists in Australia

Authors


Dr Murty Mantha, Cairns Base Hospital, P O Box 902, Cairns, Qld 4870, Australia. Email: murty_mantha@health.qld.gov.au

ABSTRACT

Aim:  Percutaneous endovascular procedures can maintain and salvage dysfunctional arteriovenous fistulae and grafts used in haemodialysis. The aim of this study is to report the experience of nephrologists from a single centre in Australia with these procedures.

Methods:  A total of 187 consecutive percutaneous vascular procedures (angioplasty, angioplasty ± thrombolysis, stent placement and accessory vein ligation) were performed in 100 haemodialysis patients with dysfunctional arteriovenous fistulae and grafts between January 2006 and July 2009 in a single centre. All relevant clinical and radiological data collected during this period were reviewed retrospectively. Post patency rates were estimated using the Kaplan–Meier method.

Results:  The clinical and anatomic success rates were 93% (172 of 184 interventions) and 91% (169 of 184 interventions), respectively. The overall complication rate was 5.9%. A major complication leading to access loss occurred in one patient (0.5%). The primary patency rates at 6, 12 and 18 months were 72%, 55% and 47%, respectively. The secondary patency rates at 6, 12 and 18 months were 96%, 93% and 90%, respectively. The mean cumulative patency was 36.8 months ± SE 1.27 (95%CI 36.8–39.3). The mean fluoroscopy screening time was 11.5 ± 8.5 min.

Conclusion:  This study demonstrates that high anatomic success and excellent patency rates can be obtained with percutaneous endovascular procedures and that appropriately trained interventional nephrologists can perform these procedures safely and effectively.

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