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CardioVascular and Interventional Radiology

, Volume 23, Issue 1, pp 40–46 | Cite as

Early detection and treatment of hemodialysis access dysfunction

  • Juan José Gallego Beuter
  • Antonio Hernández Lezana
  • José Herrero Calvo
  • Rosa Moreno Carriies
Clinical Investigations

Abstract

Purpose: To assess the usefulness of a program for the early detection of hemodialysis graft dysfunction and the impact on graft survival of percutaneous transluminal angioplasty (PTA) and stent implantation to correct venous stenosis.

Methods: A program for the early detection of hemodialysis access graft dysfunction was carried out in l 10 patients over a period of 80 months. Detection was based on physical examination, flow rate measurements, venous pressure, and analytical determinations performed at dialysis. The stenoses detected were treated by PTA or PTA plus stent deployment. Survival curves compared primary and assisted patency rates for the different graft types.

Results: The most important indicators of dysfunction were increased venous pressure and difficulty in cannulation of the graft. Significant stenoses were revealed by 227 (92.2%) of the 246 fistulography procedures performed. PTA results were satisfactory in 100% of the Thomas grafts. 74% of the Brescia-Cimino (BC) grafts, and 53% of the polytetrafluoroethylene (PTFE) grafts. Technical success rates for stent deployment were 92% for BC grafts and 100% for PTFE grafts, while functional success rates were 96% and 97%, respectively. The difference in the primary patency (PI) and assisted patency (CAP) values was statistically significant for all three graft types. There was no significant difference in the patency rates for grafts treated by PTA alone or by PTA and stent deployment.

Conclusion: A surveillance program helped prevent graft thrombosis, and intervention as required achieved excellent primary and assisted patency rates. Stent deployment salvaged a considerable number of accesses but did not significantly extend access survival time.

Key words

Hemodialysis access dysfunction Early detection Percutaneous treatment 

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Copyright information

© Springer-Verlag New York, Inc 2000

Authors and Affiliations

  • Juan José Gallego Beuter
    • 1
  • Antonio Hernández Lezana
    • 1
  • José Herrero Calvo
    • 2
  • Rosa Moreno Carriies
    • 3
  1. 1.Department of RadiologyHospital Clinico San CarlosMadridSpain
  2. 2.Department of NephrologyHospital Clinico San CarlosMadridSpain
  3. 3.Department of Vascular SurgeryHospital Clinico San CarlosMadridSpain

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