[Surgical interventions in dialysis fistulae]

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Nephrology

Context:

• End-stage renal disease necessitates reliable hemodialysis access.
• Hemodialysis shunts (fistulas and grafts) are prone to stenosis and occlusion, compromising dialysis efficacy.
• Interventional procedures offer a minimally invasive approach to maintain shunt function.

Purpose:

• To assess the efficacy, feasibility, and safety of interventional procedures for hemodialysis shunts.
• To report technical success rates and midterm primary and secondary patency rates.
• To evaluate the impact of interventions on shunt longevity.

Summary:

• A retrospective analysis of 129 interventional procedures on 87 patients with hemodialysis shunts was conducted.
• Procedures included angioplasty, thrombolysis, and thrombectomy, with a high technical success rate (84% overall, 98% for stenoses).
• Primary patency rates were 40% at 6 months, decreasing to 5% at 2 years, but primary assisted and secondary patency rates remained high (95% at 6 months, 73% at 2 years).

Impact:

• Percutaneous interventions can effectively restore and maintain hemodialysis shunt patency, particularly in cases of stenosis.
• These procedures offer a viable option to prolong the functional life of hemodialysis access, improving patient outcomes.
• Achieving good secondary patency rates underscores the value of repeated interventions in managing shunt dysfunction.