SS11. Duplex-Guided Dialysis Access Angioplasty Can Be Performed Safely in the Office Setting: Techniques, Advantages and Results

Abstract

To determine the utility of duplex guided angioplasty for hemodialysis access maturation and maintenance. Between January 2008 and June 2009, 223 office-based duplex-guided hemodialysis access angioplasty procedures were performed in 125 patients by one vascular surgeon. 208 of the treated accesses were fistulae. Maturation angioplasty was performed in 115 cases. Maintenance angioplasty was performed in 108 cases. The most common indication for intervention was maturation failure which had occurred in 104 cases. Other indications included pulsatility in 29, low access flow in 28, decreased flow in 23 and infiltration in 13. Procedures were performed in the office using a combination of topical and local anesthesia. Volume flow was recorded prior to introducer insertion (baseline) and post intervention. Stents were placed in 5 cases. Technical success was achieved in 251 cases (98.2%). Complications occurred in 21 cases (9.4%) which included introducer site hematomas (2), introducer site pseudoaneurysms (4), thrombus development (8), angioplasty site rupture (3) and angioplasty site pseudoaneurysms (2). For all interventions combined, the average baseline volume flow was 447 mL/min. The average final volume flow was 820 mL/min. The volume flow increased by an average of 83.6 % post intervention. Immature fistulas had an average baseline volume flow of 271 mL/min. Average final volume flow for these fistulae was 522 mL/min. The volume flow increased by an average of 93% after maturation angioplasty. Dysfunctional fistulae and grafts had an average baseline volume flow of 616 mL/min. Average final volume flow was 1, 143 mL/min. The volume flow increased by 85.4% after maintenance angioplasty. Duplex guided dialysis access angioplasty can be performed safely and effectively in the office setting. It offers the advantage of treating the patient without radiation or contrast. It also allows for sizing of balloons and stents and assessment of the hemodynamic effects of intervention.