SAT-051 DYSFUNCTION AUTOGENOUS HAEMODIALYSIS FISTULAS: CAUSES AND OUTCOMES AFTER FISTULOPLASTY: THE SARAWAK EXPERIENCE

Abstract

Autogenous arteriovenous fistula (AVF) dysfunction remains a major contributor to the morbidity and mortality of haemodialysis patients. Significant stenoses in AVF with limitation of flow and dialysis inadequacy should prompt immedate action. Fistuloplasty can be an effective and timely treatment for this problem but its immedate and long term outcome is variable. Type of lesions and patient-specific variables which may affect the outcome after fistuloplasty should be identified. Objective: To study the short and long term efficacy of fistuloplasty and its clinical predictors. This is a retrospective analysis of all adult haemodialysis patients who underwent arteriovenous fistuloplasties from 1st January 2012 to 31st December 2013 in our hospital. All procedures were done as inpatient by two interventional radiologists. Patients’ demographic data, cormobidities, outcomes of intervention and patency of AVF post fistuloplasty were collected from patients’ haemodialysis records until 1 November 2018. All the patients post fistuloplasty were started on double antiplatelet (DAPT) for one month and continued with single antiplatelet for lifelong if no contraindication. Results were analysed using SPSS version 16. During the study period, a total of 149 fistuloplasties were done. This cohort of haemodialysis (HD) patients has equal gender distribution with 50.3% male and 49.7% female, and the mean age was 61 + 11.9 years. Clinical indications for fistuloplasty included poor blood flow rate (62.4%), primary non maturation (26.8%), and high transmembrane pressure (5.4%). In this study, the main cause of suboptimal function of autogenous AVF was juxta-anastomotic stenosis (55.7%), followed by venous limb stenosis (13.4%) and thrombosis (4%). Some patients had multiple factors contributing to the poor function. Immedate clinical success rate which was defined as the ability to perform HD immediately after percutaneous fistuloplasty was 78.5%. More than 50% of the study patients had survival of AVF for more than 12 months. The site of AVF was statistically significant in determining the immediate outcome of fistuloplasty with the best outcome in patients with radiocephalic fistulae. However, age and gender were not predictive of outcome. Short term DAPT and life long single antiplatelet were not associated with clinically significant bleeding complications. Fistuloplasty is a safe and effective method for treating stenosis in poorly functioning AVF. This is a minimally invasive procedure with minimal complications. It can restore or improve flow immediately allowing the AVF to be used and hence avoiding the need for central venous catheters. It can also help to improve the longevity of autogenous AVF as more than 50% of our patients were still using the AVF one year after the procedure. Site of AVF appears to be the main determinant of the outcome post fistuloplasty.