P1362AN EXPERIENCE WITH PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY IN ARTERIO-VENOUS FISTULA DYSFUNCTION SECONDARY TO VASCULAR STENOSIS

Abstract

Abstract Background and Aims Arterio-venous fistula (AVF) is the life line of a hemodialysis patient. Dialysis Outcomes and Practice Study (DOPPS) showed that one year patency for AVF in the USA is 68% and 83% in Europe. The maintenance of the vascular pathways are vital. Vascular stenosis in native AVF at the anastomotic sit, venous cannulation zone, outflow vein or the central vein can lead to loss of AVF. Stenosis necessitate vascular intervention or creation of a “de novo” AVF. The number of possible vascular access sites are limited. Aim : To evaluate the outcome of percutaneous transluminal angioplasty (PTA) in arterio-venous fistula due to vascular stenosis. Method This is a retrospective study of two years (02.05.17 to 02.05.19). Records of patients admitted to our hospital were obtained from hospital archives and images from the hospital radiology archive system. Demographic characteristics, duration of dialysis, stenosis or occlusion level, patency rates of AVF were evaluated. All procedures were performed by interventional radiologists in a hybrid cath lab. Antegrade, retrograde, or both antegrade and retrograde punctures were used, depending on the site of the stenosis as deemed on preoperative ultrasound. A complete angiogram from the proximal arteriovenous anastomosis to the central venous outflow was performed in all cases. A successful percutaneous balloon angioplasty was defined when there was no more than 30% residual stenosis (KDOQI). Primary patency rates were assessed at six months and one year. Results Total number of patients studied were 16. The average age was 66.6 years. All were hypertensive and diabetics comprised 75% of study group. Coronary artery disease was established in 81.25%, and two patients were known to have chronic liver disease. Most common type of AVF was the left brachio-cephalic (62.5%), followed by radio-cephalic (37.5%). Average dialysis vintage of AVF at the time of procedure was one year. Previously failed AVF was present in two patients. There were 18 vascular stenosis in 16 patients. The most common site of stenosis was the venous cannulation zone (62.5%), followed by anastomotic site stenosis (31.5%) and central vein stenosis (18.75%). Successful PTA was done in 12 patients. There were no complications; hemodialysis was resumed within 24 hours after the procedure. The primary patency rate at three months was 100%, six months was 75% and at one year it was 37.5%. Four patients were lost to follow up. Mean follow up was 9.41 ±6.79 months. None underwent a repeat PTA. Conclusion Percutaneous transluminal angioplasty is effective for salvaging arterio-venous fistula in majority of hemodialysis patients.