Abstract
Purpose
To evaluate long-term primary and secondary patency results of drug-eluting balloon angioplasty for the treatment of juxta-anastomotic stenoses in distal radiocephalic arteriovenous fistulas.
Materials and Methods
Thirty-eight patients with juxta-anastomotic stenotic distal radiocephalic arteriovenous fistulas who underwent endovascular treatment with drug-eluting balloons between January 2014 and August 2016 in our interventional radiology department were included in this retrospective study. Color Doppler examination for follow-up was performed 15 days, 6 months, 12 months, 18 months, 24 months, 36 months, and 48 months after the procedure. Kaplan–Meier analysis was used to estimate primary and secondary patency rates.
Results
Totally, 42 angioplasty with drug-eluting balloons was performed in 38 patients (20 men and 18 women; mean age 66.42 ± 12.01). Technical and clinical success rate was 100% (42/42). The mean follow-up period was 27.71 months ± 12.98 (range, 1–54 months). The estimated primary patency rates at 6 months were 94.7% (95% CI, 80.9%–99.0%), at 12 months were 81.2% (95% CI, 64.6%–91.4%), at 24 months were 60.7% (95% CI, 43.6%–75.7%), and at 48 months were 53.1% (95% CI, 36.5%–69.1%). The estimated secondary patency rates at 6 months were 97.3% (95% CI, 84.5%–99.8%), at 12 months were 86.5% (95% CI, 70.7%–94.8%), at 24 months were 69.0% (95% CI, 51.8%–82.4%), and at 48 months were 61.7% (95% CI, 44.6%–76.5%).
Conclusion
Drug-eluting balloon angioplasty is a useful, effective technique in dysfunctional radiocephalic fistulas due to juxta-anastomotic stenoses. We demonstrated remarkably high primary patency rates at 6, 12, 24, and 48 months.
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References
Perico N, Remuzzi G. Chronic kidney disease: a research and public health priority. Nephrol Dial Transpl. 2012;27(Suppl 3):19–26.
NKF-K/DOQI. DOQI clinical practice guidelines for vascular access: update 2000. Am J Kidney Dis. 2001;37(Suppl 1):S137–81.
Santoro D, Benedetto F, Mondello P, Pipitò N, Barillà D, Spinelli F, et al. Vascular access for hemodialysis: current perspectives. Int J Nephrol Renovasc Dis. 2014;8(7):281–94.
Asif A, Gadalean FN, Merrill D, Cherla G, Cipleu CD, Epstein DL, et al. Inflow stenosis in arteriovenous fistulas and grafts: a multicenter, prospective study. Kidney Int. 2005;67(5):1986–92.
Clark TW, Hirsch DA, Jindal KJ, Veugelers PJ, LeBlanc J. Outcome and prognostic factors of restenosis after percutaneous treatment of native hemodialysis fistulas. J Vasc Interv Radiol. 2002;13(1):51–9.
Asif A, Lenz O, Merrill D, Cherla G, Cipleu CD, Ellis R, et al. Percutaneous management of perianastomotic stenosis in arteriovenous fistulae: results of a prospective study. Kidney Int. 2006;69(10):1904–9.
Patanè D, Giuffrida S, Morale W, L’Anfusa G, Puliatti D, Bisceglie P, et al. Drug-eluting balloon for the treatment of failing hemodialytic radiocephalic arteriovenous fistulas: our experience in the treatment of juxta-anastomotic stenoses. J Vasc Access. 2014;15(5):338–43.
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(2):508–15.
Tapping CR, Mallinson PI, Scott PM, Robinson GJ, Lakshminarayan R, Ettles DF. Clinical outcomes following endovascular treatment of the malfunctioning autologous dialysis fistula. J Med Imaging Radiat Oncol. 2010;54(6):534–40.
Turmel-Rodrigues L, Pengloan J, Baudin S, Testou D, Abaza M, Dahdah G, et al. Treatment of stenosis and thrombosis in haemodialysis fistulas and grafts by interventional radiology. Nephrol Dial Transpl. 2000;15(12):2029–36.
Tepe G, Zeller T, Albrecht T, Heller S, Schwarzwälder U, Beregi JP, et al. Local delivery of paclitaxel to inhibit restenosis during angioplasty of the leg. N Engl J Med. 2008;358(7):689–99.
Lučev J, Breznik S, Dinevski D, Ekart R, Rupreht M. Endovascular treatment of haemodialysis arteriovenous fistula with drug-coated balloon angioplasty: a single-centre study. Cardiovasc Interv Radiol. 2018;41(6):882–9.
Wo K, Morrison BJ, Harada RN. Developing duplex ultrasound criteria for diagnosis of arteriovenous fistula stenosis. Ann Vasc Surg. 2017;38:99–104.
Beathard GA, Arnold P, Jackson J, Litchfield T. Aggressive treatment of early fistula ailure. Kidney Int. 2003;64(4):1487–94.
Gray RJ, Sacks D, Martin LG, Trerotola SO. Reporting standards for percutaneous interventions in dialysis access. J Vasc Interv Radiol. 2003;14(9 Pt 2):S433–42.
Filippiadis DK, Binkert C, Pellerin O, Hoffmann RT, Krajina A, Pereira PL. Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Interv Radiol. 2017;40(8):1141–6.
Manninen HI, Kaukanen ET, Ikäheimo R, Karhapää P, Lahtinen T, Matsi P, et al. Brachial arterial access: endovascular treatment of failing Brescia-Cimino hemodialysis fistulas–initial success and long-term results. Radiology. 2001;218(3):711–8.
Patanè D, Failla G, Coniglio G, Russo G, Morale W, Seminara G, et al. Treatment of juxta-anastomotic stenoses for failing distal radiocephalic arteriovenous fistulas: drug-coated balloons versus angioplasty. J Vasc Access. 2018;30:1129729818793102.
Jiménez-Almonacid P, Gruss-Vergara E, Jiménez-Toscano M, Lasala M, Rueda JA, Portolés J, et al. Surgical treatment of juxta-anastomotic stenosis in radiocephalic fistula. A new proximal radiocephalic anastomosis. Nefrologia. 2012;32(4):517–22.
Kwon H, Choi JY, Ko HK, Kim MJ, Kim H, Park H, et al. Comparison of surgical and endovascular salvage procedures for juxta-anastomotic stenosis in autogenous wrist radiocephalic arteriovenous fistula. Ann Vasc Surg. 2014;28(8):1840–6.
Katsanos K, Karnabatidis D, Kitrou P, Spiliopoulos S, Christeas N, Siablis D. Paclitaxel-coated balloon angioplasty vs. plain balloon dilation for the treatment of failing dialysis access: 6-month interim results from a prospective randomized controlled trial. J Endovasc Ther. 2012;19(2):263–72.
Kitrou PM, Katsanos K, Spiliopoulos S, Karnabatidis D, Siablis D. Drug-eluting versus plain balloon angioplasty for the treatment of failing dialysis access: final results and cost-effectiveness analysis from a prospective randomized controlled trial (NCT01174472). Eur J Radiol. 2015;84(3):418–23.
Kohler TR, Toleikis PM, Gravett DM, Avelar RL. Inhibition of neointimal hyperplasia in a sheep model of dialysis access failure with the bioabsorbable Vascular Wrap paclitaxel-eluting mesh. J Vasc Surg. 2007;45(5):1029–37.
Kelly B, Melhem M, Zhang J, Kasting G, Li J, Krishnamoorthy M, et al. Perivascular paclitaxel wraps block arteriovenous graft stenosis in a pig model. Nephrol Dial Transpl. 2006;21(9):2425–31.
Kim WS, Pyun WB, Kang BC. The primary patency of percutaneous transluminal angioplasty in hemodialysis patients with vascular access failure. Korean Circ J. 2011;41(9):512–7.
Mantha M, Killen JP, Baer R, Moffat J. Percutaneous maintenance and salvage of dysfunctional arteriovenous fistulae and grafts by nephrologists in Australia. Nephrology. 2011;16(1):46–52.
Long B, Brichart N, Lermusiaux P, Turmel-Rodrigues L, Artru B, Boutin JM, et al. Management of perianastomotic stenosis of direct wrist autogenous radial-cephalic arteriovenous accesses for dialysis. J Vasc Surg. 2011;53(1):108–14.
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(4):558–64.
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This study was carried out in Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.
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Gulcu, A., Sarioglu, O., Peker, A. et al. Drug-Eluting Balloon Angioplasty for Juxta-Anastomotic Stenoses in Distal Radiocephalic Hemodialysis Fistulas: Long-Term Patency Results. Cardiovasc Intervent Radiol 42, 835–840 (2019). https://doi.org/10.1007/s00270-019-02213-w
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DOI: https://doi.org/10.1007/s00270-019-02213-w