Skip to main content

Advertisement

SpringerLink
Log in

Factors affecting patency of arteriovenous fistula following first percutaneous transluminal angioplasty

  • Original article
  • Published:
Clinical and Experimental Nephrology Aims and scope Submit manuscript

Abstract

Background

Percutaneous transluminal angioplasty (PTA) has generally replaced surgical procedures to treat arteriovenous fistula (AVF) dysfunction, but the predictors of post-intervention patency are highly variable. This study aimed to determine predictors of primary patency following PTA of dysfunctional AVF.

Materials and methods

Retrospective analysis of first-time PTA of 307 AVF in 307 patients (171 males, mean age 64.3 ± 12.4 years). Demographic, clinical, anatomical and medication variables were reviewed and subjected to univariate and multivariate Cox regression analysis.

Results

The post-intervention primary patency rates at 6, 12, 24, and 36 months were 76.3%, 58.3%, 43.2%, and 38.2%, respectively. The higher aortic arch calcification (AAC) grade patients were older, had higher incidence of comorbidities and cardiomegaly, and younger AVF age, but their dialysis vintage term was shorter and diastolic blood pressure was lower, and the maximum diameter of balloon angioplasty was mostly ≤ 6 mm, and had lower phosphorus level and less calcium-containing phosphate binder use. In multivariate Cox proportional hazard analysis, the presence of higher AAC grade [hazard ratio (95% confidence interval): (1.46 (1.02–2.09); p = 0.037)] and stenosis at upper arm [1.76 (1.16–2.67); p = 0.008] were associated with shorter post-intervention primary patency.

Conclusion

In conclusion, higher AAC grade and anatomic factor related to the location of AVF (upper arm) were the important predictors of AVF dysfunction after PTA. These results could assist in tailoring surveillance programs and performing appropriate interventions for risky AVF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006;48(Suppl 1):S176–247.

    Google Scholar 

  2. Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006;48(Suppl 1):S248–273.

    Google Scholar 

  3. Mortamais J, Papillard M, Girouin N, Boutier R, Cougnaud L, Martin X, et al. Endovascular treatment of juxta-anastomotic venous stenoses of forearm radiocephalic fistulas: long-term results and prognostic factors. J Vasc Interv Radiol. 2013;24:558–64.

    Article  Google Scholar 

  4. Neuen BL, Gunnarsson R, Baer RA, Tosenovsky P, Green SJ, Golledge J, et al. Factors associated with patency following angioplasty of hemodialysis fistulae. J Vasc Interv Radiol. 2014;25:1419–26.

    Article  Google Scholar 

  5. Heye S, Maleux G, Vaninbroukx J, Claes K, Kuypers D, Oyen R. Factors influencing technical success and outcome of percutaneous balloon angioplasty in de novo native hemodialysis arteriovenous fistulas. Eur J Radiol. 2012;81:2298–303.

    Article  Google Scholar 

  6. Romann A, Beaulieu MC, Rheaume P, Clement J, Sidhu R, Kiaii M. Risk factors associated with arteriovenous fistula failure after first radiologic intervention. J Vasc Access. 2016;17:167–74.

    Article  Google Scholar 

  7. Bountouris I, Kristmundsson T. Is repeat PTA of a failing hemodialysis fistula durable? Int J Vasc Med. 2014;2014:369687.

    PubMed  PubMed Central  Google Scholar 

  8. Wu CC, Wen SC, Yang CW, Pu SY, Tsai KC, Chen JW. Baseline plasma glycemic profiles but not inflammatory biomarkers predict symptomatic restenosis after angioplasty of arteriovenous fistulas in patients with hemodialysis. Atherosclerosis. 2010;209:598–600.

    Article  CAS  Google Scholar 

  9. Tessitore N, Mansueto G, Bedogna V, Lipari G, Poli A, Gammaro L, et al. A prospective controlled trial on effect of percutaneous transluminal angioplasty on functioning arteriovenous fistulae survival. J Am Soc Nephrol. 2003;14:1623–7.

    Article  Google Scholar 

  10. Gray RJ, Sacks D, Martin LG, Trerotola SO. Reporting standards for percutaneous interventions in dialysis access. J Vasc Interv Radiol. 2003;14:S433–S442442.

    Article  Google Scholar 

  11. Yap YS, Ting KT, Chi WC, Lin CH, Liu YC, Chuang WL. Aortic arch calcification predicts patency loss of arteriovenous fistula in end-stage renal disease patients. Sci Rep. 2016;6:24943.

    Article  CAS  Google Scholar 

  12. Yap YS, Ting KT, Chi WC, Lin CH, Liu YC, Kuo PL, et al. Aortic arch calcification as a predictor of repeated arteriovenous fistula failure within 1-year in hemodialysis patients. Biomed Res Int. 2017;2017:6728437.

    Article  Google Scholar 

  13. Kim HG, Park SC, Lee SL, Shin OR, Yoon SA, Yang CW, et al. Arterial micro-calcification of vascular access is associated with aortic arch calcification and arterial stiffness in hemodialysis patients. Semin Dial. 2013;26:216–22.

    Article  Google Scholar 

  14. Choi SJ, Yoon HE, Kim YS, Yoon SA, Yang CW, Kim YS, et al. Pre-existing arterial micro-calcification predicts primary unassisted arteriovenous fistula failure in incident hemodialysis patients. Semin Dial. 2015;28:665–9.

    Article  Google Scholar 

  15. Georgiadis GS, Georgakarakos EI, Antoniou GA, Panagoutsos S, Argyriou C, Mourvati E, et al. Correlation of pre-existing radial artery macrocalcifications with late patency of primary radiocephalic fistulas in diabetic hemodialysis patients. J Vasc Surg. 2014;60:462–70.

    Article  Google Scholar 

  16. Fujimoto H, Nakamura M, Yokoi H. Impact of calcification on the long-term outcomes of sirolimus-eluting stent implantation: subanalysis of the cypher post-marketing surveillance registry. Circ J. 2012;76:57–64.

    Article  Google Scholar 

  17. Tanabe K, Kishi S, Aoki J, Tanimoto S, Onuma Y, Yachi S, et al. Impact of coronary calcium on outcome following sirolimus-eluting stent implantation. Am J Cardiol. 2011;108:514–7.

    Article  CAS  Google Scholar 

  18. Bakken AM, Palchik E, Hart JP, Rhodes JM, Saad WE, Davies MG. Impact of diabetes mellitus on outcomes of superficial femoral artery endoluminal interventions. J Vasc Surg. 2007;46:946–58.

    Article  Google Scholar 

  19. Asif A, Roy-Chaudhury P, Beathard GA. Early arteriovenous fistula failure: a logical proposal for when and how to intervene. Clin J Am Soc Nephrol. 2006;1:332–9.

    Article  Google Scholar 

  20. Browne LD, Bashar K, Griffin P, Kavanagh EG, Walsh SR, Walsh MT. The role of shear stress in arteriovenous fistula maturation and failure: a systematic review. PLoS ONE. 2015;10:e0145795.

    Article  Google Scholar 

  21. Kheda MF, Brenner LE, Patel MJ, Wynn JJ, White JJ, Prisant LM, et al. Influence of arterial elasticity and vessel dilatation on arteriovenous fistula maturation: a prospective cohort study. Nephrol Dial Transplant. 2010;25:525–31.

    Article  Google Scholar 

  22. Marshall AP, Luo W, Wang XL, Lin T, Cai Y, Guzman RJ. Medial artery calcification increases neointimal hyperplasia after balloon injury. Sci Rep. 2019;9:8193.

    Article  Google Scholar 

  23. Rajan DK, Bunston S, Misra S, Pinto R, Lok CE. Dysfunctional autogenous hemodialysis fistulas: outcomes after angioplasty—are there clinical predictors of patency? Radiology. 2004;232:508–15.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Internal Medicine, Yuan’s General Hospital, No. 162, Chenggong 1st Road, LingYa District, Kaohsiung City, 802, Taiwan, ROC

    Yit-Sheung Yap, Wen-Che Chi, Cheng-Hao Lin & Yi-Chun Liu

  2. Chronic Kidney Disease Education Center, Yuan’s General Hospital, Kaohsiung, 802, Taiwan

    Yi-Wen Wu

  3. Hemodialysis Center, Yuan’s General Hospital, Kaohsiung, 802, Taiwan

    Hui-Yueh Yang

Authors
  1. Yit-Sheung Yap
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wen-Che Chi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cheng-Hao Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yi-Chun Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yi-Wen Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hui-Yueh Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yit-Sheung Yap.

Ethics declarations

Conflict of interest

The authors have declared that no conflict of interest exists.

Ethical approval

All procedures performed involving human participants were in accordance with the ethical standards of the Ethics Committee of Yuan’s General Hospital (No. 20191011B), Taiwan and in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The requirement for informed patient consent was waived given the retrospective nature of the study and minimal participant risk.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yap, YS., Chi, WC., Lin, CH. et al. Factors affecting patency of arteriovenous fistula following first percutaneous transluminal angioplasty. Clin Exp Nephrol 25, 80–86 (2021). https://doi.org/10.1007/s10157-020-01958-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10157-020-01958-w

Keywords

Search

Navigation