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The percutaneous treatment of angioaccess graft complications
Insights
Percutaneous techniques are effective for failing angioaccess grafts, particularly those with stenoses away from the venous anastomosis. Their efficacy decreases for occluded grafts in hemodialysis patients.
Area of Science:
- Vascular Surgery
- Interventional Nephrology
- Dialysis Access Management
Background:
- Percutaneous techniques are increasingly used for angioaccess graft complications.
- The effectiveness of these procedures in hemodialysis patients is not well-established.
Purpose of the Study:
- To evaluate the outcomes of percutaneous interventions for failing angioaccess grafts.
- To identify factors influencing the success of these procedures.
Main Methods:
- Retrospective review of patients undergoing percutaneous treatment for angioaccess grafts.
- Analysis of patient demographics, intervention types, and treatment outcomes.
- Kaplan-Meier survival analysis and log-rank testing for patency rates.
Main Results:
- Grafts not needing thrombolysis showed significantly higher patency rates.
- Angioplasty of stenoses remote from the anastomosis yielded better patency than venous anastomotic dilatation.
Conclusions:
- Percutaneous treatment is most effective for failing, patent angioaccess grafts with stenoses distant from the anastomosis.
- Efficacy is reduced for occluded grafts, highlighting the importance of early intervention.
Background:
In the last decade, percutaneous techniques have been used with increasing frequency to treat angioaccess graft complications. The role of these procedures and their outcomes in patients on hemodialysis remains unclear.
Patients And Methods:
The records of all patients receiving percutaneous treatment of failed or failing angioaccess grafts were reviewed. Patient demographics, site and type of percutaneous intervention, and results of treatment were recorded. Survival curves were plotted using the Kaplan-Meier method, and differences in times to first failure between types of intervention were tested using the log rank method.
Results:
Grafts not requiring thrombolysis had significantly higher patency rates than those that did (P < 0.0001). Patency of grafts undergoing angioplasty of sites remote from the venous anastomosis were significantly higher than those of grafts undergoing venous anastomotic dilatation (P = 0.0004).
Conclusions:
Percutaneous techniques are most effective in treating failing but patent angioaccess grafts, especially those with stenoses remote from the venous anastomosis. The efficacy of percutaneous techniques diminishes significantly when used to treat grafts that have progressed to occlusion.