Endovascular bypass for salvage of vascular access in hemodialysis catheter-consigned patients
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Published on: May 31, 2022
Matt Chiung-Yu Chen1, Mei-Jui Weng2, Huei-Lung Liang2
11 Department of Interventional Radiology, Yuan's General Hospital, Kaohsiung, Taiwan.
Insights
Endovascular bypass effectively salvages abandoned hemodialysis vascular access sites. This technique offers a feasible and successful alternative when surgical revision isn't an option for catheter-dependent patients.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Nephrology
Background:
- Vascular access is crucial for hemodialysis patients.
- Abandoned access sites pose challenges for continued treatment.
- Salvage options are needed for compromised vascular access.
Purpose of the Study:
- To assess the efficacy of endovascular bypass for salvaging abandoned vascular access sites.
- To evaluate the use of percutaneous intervascular bypass with or without stent grafts.
- To determine patency rates and success in hemodialysis catheter patients.
Main Methods:
- Retrospective analysis of 16 patients undergoing endovascular bypass.
- Technique involved redirecting access flow to a new vein.
- Kaplan-Meier method used to calculate patency rates.
Main Results:
- 100% procedural and clinical success rates.
- 360-day primary patency rates: 75.7% for bypass, 56.8% for access site.
- Mean follow-up of 461.9 days with no major complications.
Conclusions:
- Endovascular bypass is technically feasible and clinically successful for salvaging abandoned vascular access sites.
- This technique is a viable option for hemodialysis patients when surgical revision is not possible.
- Selected patients can benefit from endovascular bypass for continued hemodialysis access.
Purpose::
This study was performed to retrospectively assess the efficacy of percutaneous creation of an intervascular bypass with or without stent graft deployment (endovascular bypass) for salvage of abandoned vascular access sites in hemodialysis catheter-consigned patients.
Methods::
Salvage of abandoned vascular access sites was attempted in 16 patients with hemodialysis catheters. These vascular access sites were salvaged using endovascular bypass techniques to redirect the access flow to a nonarterialized vein as a new outflow conduit or cannulation segment. The postintervention primary, assisted primary, and secondary patency rates of the access site and bypass were calculated using the Kaplan-Meier method.
Results::
The procedural and clinical success rates were both 100%. The postintervention primary patency rate of the bypass and access site at 360 days was 75.7 ± 12.5% and 56.8 ± 14.9%, respectively. The mean follow-up period was 461.9 days (range: 121-900 days). No major complications were observed. One bare bypass tunnel rupture and one pseudoaneurysm were noted during the procedure.
Conclusion::
Salvage of abandoned vascular access sites for hemodialysis catheter-consigned patients can be technically feasible and clinically successful using endovascular bypass techniques in selected patients when surgical revision is not considered or is not possible.
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