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Percutaneous interventions in failing "necklace" hemodialysis grafts: long-term outcomes
Adi J Price1, Nicholas Fidelman1, Mark W Wilson1
1Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., Room M-361, San Francisco, CA 94143.
Insights
Percutaneous interventions effectively maintained patency in malfunctioning anterior chest wall arteriovenous grafts (AVGs) for hemodialysis. However, patency rates were lower than those recommended for extremity AVGs.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Nephrology
Background:
- Anterior chest wall arteriovenous grafts (AVGs), often termed "necklace" grafts, are used for hemodialysis access.
- Malfunctioning AVGs require interventions to maintain patency.
- Percutaneous interventions are a common treatment modality for AVG dysfunction.
Purpose of the Study:
- To evaluate the primary and secondary patency rates of percutaneous interventions for malfunctioning necklace AVGs.
- To assess the effectiveness of these interventions in maintaining hemodialysis access.
Main Methods:
- A retrospective review of six patients with necklace AVGs who underwent 34 percutaneous procedures.
- Procedures included balloon angioplasty, pharmacomechanical thrombolysis, and stent placement.
- Calculation of primary and secondary patency intervals after graft placement and intervention.
Main Results:
- At 3 months, primary and secondary patency rates were 33% and 67%, respectively.
- At 12 months, primary and secondary patency rates decreased to 17% and 50%.
- The anatomic success rate of percutaneous interventions was high (97%), but long-term patency was inferior to extremity AVG guidelines.
Conclusions:
- Percutaneous interventions are effective in maintaining patency for failing necklace AVGs.
- The primary and secondary patency rates achieved were lower than established guidelines for extremity AVGs.
- Further research may be needed to optimize outcomes for necklace AVG interventions.
Purpose:
To determine primary and secondary patency after percutaneous interventions for malfunctioning anterior chest wall ("necklace") arteriovenous grafts (AVGs) for hemodialysis.
Materials And Methods:
Records of six consecutive patients with subclavian artery-to-contralateral subclavian vein necklace AVGs were reviewed. Patients underwent 34 procedures, including 28 balloon angioplasties, 24 pharmacomechanical thrombolyses, and six stent placements. Patency intervals after graft placement and after first intervention were calculated.
Results:
After 3 months, primary and secondary patency rates were 33% (two of six grafts) and 67% (four of six grafts), respectively. At 12 months, primary and secondary patency rates were 17% (one of six grafts) and 50% (three of six grafts), respectively. Median and mean primary patency times were 49 and 374 days, and median and mean secondary patency times were 293 and 575 days, respectively. The anatomic success rate of percutaneous interventions in malfunctioning AVGs was 97% (33 of 34 cases). At 3 years after implantation, the graft patency rate was 57% (four of seven grafts).
Conclusions:
Percutaneous interventions were effective at maintaining patency in failing necklace AVGs. However, their primary and secondary patency were inferior to those cited in extremity AVG guidelines set forth by the Society of Interventional Radiology.
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