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Dialysis access fistulas: treatment of stenoses by transluminal angioplasty
Insights
Balloon angioplasty effectively treats upper-extremity dialysis access fistulas, with 70% initial success. While patency decreases over time, complications are minimal, suggesting outpatient feasibility.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Nephrology
Background:
- Dialysis access fistulas are crucial for hemodialysis.
- Stenotic lesions can compromise fistula function.
- Balloon angioplasty is a common intervention for these stenoses.
Observation:
- Fifty-six balloon dilatations were performed on 51 patients with upper-extremity dialysis access fistulas.
- Lesions treated included venous anastomoses, arterial anastomoses, and distant venous stenoses.
- The procedures were conducted over a 4-year period.
Findings:
- Initial success rate for balloon dilatations was 70% (39/56).
- Patency rates at 3 months, 6 months, 1 year, 2 years, and 3 years were 80%, 70%, 55%, 50%, and 33%, respectively.
- Complications occurred in 5% of cases (two graft thromboses, one pseudoaneurysm).
Implications:
- Balloon angioplasty is a viable option for managing upper-extremity dialysis access stenosis.
- While long-term patency declines, the procedure demonstrates a low complication rate.
- Outpatient management is feasible, potentially reducing healthcare costs and improving patient convenience.
Abstract:
Fifty-six balloon dilatations in 51 patients with upper-extremity dialysis access fistulas were performed over a 4-year period. Forty-four venous anastomotic lesions in patients with either internal or graft fistulas were dilated. Three arterial anastomotic lesions and nine distant venous stenoses were treated. Thirty-nine of 56 (70%) dilatations were initially successful. Of the initial successes, 28/35 (80%) were patent at 3 months, 19/27 (70%) at 6 months, 12/22 (55%) at 1 year, 7/14 (50%) at 2 years, and 3/9 (33%) at 3 years. Three complications (5%) were encountered. These included two graft thromboses and one pseudoaneurysm at the dilatation site. The procedure may be performed on an outpatient basis.