Outcomes of Endovascular Therapy for Salvage of Hemodialysis Arteriovenous Fistulae
Introduction Arteriovenous fistulae (AVF) for hemodialysis (HD) are prone to development of multiple complications, which can lead to nonfunctioning of the fistula. We report outcomes of endovascular management for dysfunctional HD AVF. Materials and Methods In this prospective study, pat...
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Thieme Medical and Scientific Publishers Pvt. Ltd.
2021-06-01
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| Series: | Journal of Clinical Interventional Radiology ISVIR |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1728983 |
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| author | Nishtha Yadav Shivanand Gamanagatti Raju Sharma Sanjay Kumar Aggarwal V. K. Bansal Devasenathipathy Kandasamy V. Seenu |
| author_facet | Nishtha Yadav Shivanand Gamanagatti Raju Sharma Sanjay Kumar Aggarwal V. K. Bansal Devasenathipathy Kandasamy V. Seenu |
| author_sort | Nishtha Yadav |
| collection | DOAJ |
| description | Introduction Arteriovenous fistulae (AVF) for hemodialysis (HD) are prone to development of multiple complications, which can lead to nonfunctioning of the fistula. We report outcomes of endovascular management for dysfunctional HD AVF.
Materials and Methods In this prospective study, patients (43 men, 28 women, mean age 47.4 years) with clinical signs and symptoms of dysfunctional HD AVF and referred to interventional radiology for endovascular management were included. The most common clinical presentation included low flows during hemodialysis (n = 20), absent flow (n = 37), and failure of fistula maturation (n = 14). Patients with central venous obstruction who presented with limb swelling were excluded from this study. Patients underwent venography, venoplasty and thrombectomy, as appropriate, to salvage the fistula. The study outcomes were technical success, hemodynamic success, and clinical success of endovascular therapies in salvaging the fistulae.
Results The technical, hemodynamic and clinical success rates of endovascular therapy for low-flow symptoms were 95%, 70% and 95%, respectively. Among patients who presented with absent flow, endovascular therapy had 81% technical success, 78.3% hemodynamic success, and 81% clinical success. Endovascular therapy was associated with 64.2% technical success, 57.1% hemodynamic success, and 64.2% clinical success in patients presenting with failed maturation of the fistula. The overall clinical success rate was 58/71 (81.7%) and failure rate was 13/71 (18.3%). The overall complication rate of endovascular therapy was 8.4% and the complications included vein rupture in 5 (7%) and balloon rupture in 1 (1.4%).
Conclusion Endovascular therapy for salvage of nonfunctioning hemodialysis AVF is associated with a high-clinical success rate (81.7%) and low-complication rate. |
| format | Article |
| id | doaj-art-82ccec42fd7849ad9680a6baff8e778b |
| institution | OA Journals |
| issn | 2456-4869 |
| language | English |
| publishDate | 2021-06-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
| record_format | Article |
| series | Journal of Clinical Interventional Radiology ISVIR |
| spelling | doaj-art-82ccec42fd7849ad9680a6baff8e778b2025-08-20T02:08:46ZengThieme Medical and Scientific Publishers Pvt. Ltd.Journal of Clinical Interventional Radiology ISVIR2456-48692021-06-01050314214910.1055/s-0041-1728983Outcomes of Endovascular Therapy for Salvage of Hemodialysis Arteriovenous FistulaeNishtha Yadav0Shivanand Gamanagatti1Raju Sharma2Sanjay Kumar Aggarwal3V. K. Bansal4Devasenathipathy Kandasamy5V. Seenu6Department of Radiology, Super Speciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, IndiaDepartment of Radiology, All India Institute of Medical Sciences, New Delhi, IndiaDepartment of Radiology, All India Institute of Medical Sciences, New Delhi, IndiaDepartment of Nephrology, All India Institute of Medical Sciences, New Delhi, IndiaDepartment of Surgery, All India Institute of Medical Sciences, New Delhi, IndiaDepartment of Radiology, All India Institute of Medical Sciences, New Delhi, IndiaDepartment of Surgery, All India Institute of Medical Sciences, New Delhi, IndiaIntroduction Arteriovenous fistulae (AVF) for hemodialysis (HD) are prone to development of multiple complications, which can lead to nonfunctioning of the fistula. We report outcomes of endovascular management for dysfunctional HD AVF. Materials and Methods In this prospective study, patients (43 men, 28 women, mean age 47.4 years) with clinical signs and symptoms of dysfunctional HD AVF and referred to interventional radiology for endovascular management were included. The most common clinical presentation included low flows during hemodialysis (n = 20), absent flow (n = 37), and failure of fistula maturation (n = 14). Patients with central venous obstruction who presented with limb swelling were excluded from this study. Patients underwent venography, venoplasty and thrombectomy, as appropriate, to salvage the fistula. The study outcomes were technical success, hemodynamic success, and clinical success of endovascular therapies in salvaging the fistulae. Results The technical, hemodynamic and clinical success rates of endovascular therapy for low-flow symptoms were 95%, 70% and 95%, respectively. Among patients who presented with absent flow, endovascular therapy had 81% technical success, 78.3% hemodynamic success, and 81% clinical success. Endovascular therapy was associated with 64.2% technical success, 57.1% hemodynamic success, and 64.2% clinical success in patients presenting with failed maturation of the fistula. The overall clinical success rate was 58/71 (81.7%) and failure rate was 13/71 (18.3%). The overall complication rate of endovascular therapy was 8.4% and the complications included vein rupture in 5 (7%) and balloon rupture in 1 (1.4%). Conclusion Endovascular therapy for salvage of nonfunctioning hemodialysis AVF is associated with a high-clinical success rate (81.7%) and low-complication rate.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1728983arteriovenous fistulahemodialysis accessinterventional radiologyballoon dilatationvenoplasty |
| spellingShingle | Nishtha Yadav Shivanand Gamanagatti Raju Sharma Sanjay Kumar Aggarwal V. K. Bansal Devasenathipathy Kandasamy V. Seenu Outcomes of Endovascular Therapy for Salvage of Hemodialysis Arteriovenous Fistulae Journal of Clinical Interventional Radiology ISVIR arteriovenous fistula hemodialysis access interventional radiology balloon dilatation venoplasty |
| title | Outcomes of Endovascular Therapy for Salvage of Hemodialysis Arteriovenous Fistulae |
| title_full | Outcomes of Endovascular Therapy for Salvage of Hemodialysis Arteriovenous Fistulae |
| title_fullStr | Outcomes of Endovascular Therapy for Salvage of Hemodialysis Arteriovenous Fistulae |
| title_full_unstemmed | Outcomes of Endovascular Therapy for Salvage of Hemodialysis Arteriovenous Fistulae |
| title_short | Outcomes of Endovascular Therapy for Salvage of Hemodialysis Arteriovenous Fistulae |
| title_sort | outcomes of endovascular therapy for salvage of hemodialysis arteriovenous fistulae |
| topic | arteriovenous fistula hemodialysis access interventional radiology balloon dilatation venoplasty |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1728983 |
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