One-year Primary Patency Rates Research Articles

Clinical efficacy of a modified no-touch technique in the establishment of autologous arteriovenous fistula

Objective: To explore the clinical efficacy of a modified no-touch technique (MNTT) in establishing autogenous arteriovenous fistulas (AVF) in hemodialysis patients. Methods: A total of 63 patients with AVF which was first established by MNTT in the Department of Nephrology, Suzhou Science and Technology Town Hospital from January 2021 to August 2022 were retrospectively included. The clinical data, ultrasound evaluation data of AVF, AVF maturity rate and AVF patency rate were collected. Subsequently, the AVF rate of patients in the MNTT group was compared with the patency rate of patients in the conventional operation group in the same hospital from January 2019 to December 2020. The Kaplan-Meier method was used to draw the survival curve, and the log-rank test was used to compare the difference in postoperative patency rate between the two groups. Results: There were 63 cases in the MNTT group, with 39 males and 24 females, and aged (60±17) years. Meanwhile, there were 40 cases in the conventional operation group, including 23 males and 17 females, and aged (60±13) years. In the MNTT group, the immediate patency rate was 100% (63/63) after surgery, and the AVF maturation rate at 2, 4 and 8 weeks postoperatively were 54.0% (34/63), 85.7% (54/63), and 90.5% (57/63), respectively. The primary patency rate was 90.0% (45/50), 85.0% (34/40), 82.9% (29/35), and 81.0% (17/21) at 3, 6, 9 months, and 1 year after the operation, respectively, and the assisted patency rates were all 100.0%. The one-year primary patency rate in the MNTT group was higher than that in the conventional surgery group (81.0% versus 63.5%, log-rank χ2=5.12, P=0.023). Ultrasound results showed that in the MNTT group, AVF veins were evenly dilated, the vascular wall gradually thickened, the brachial artery blood flow gradually increased, and spiral laminar flow occurred in the cephalic vein and radial artery. Conclusion: AVF established by MNTT features with fast maturity and a high patency rate, which is worthy of clinical promotion.

Prospective study comparing drug coated balloons versus balloon angioplasty for management of critical limb ischemia patients with tibial occlusive disease

Background: For years interventionists have been searching for a technique of angioplasty to provide a reasonable patency without leaving something behind, and drug coated balloons came as the answer long waited with very promising preliminary results. This study aimed to compare between plain balloons and drug coated balloons as regard patency and limb salvage in treating tibial atherosclerotic occlusive disease. Methods: A prospective, randomized study. Patients with CTLI due to tibial atherosclerotic occlusive disease with or without concomitant inflow involvement are randomized into 2 groups, group A standard balloon angioplasty and group B drug coated balloons in a ratio of 2: 1. All patients were followed up for 12 months both clinically and radiologically for patency, limb salvage and wound healing. Results: No statistically significant differences were found regarding demographic data, co-morbidities, and risk factors between both groups. 93.3% of patients were diabetics. The one-year primary patency rates differ between the two approaches only at 12 months and was better for the DCB group (P-value 0.004). The one-year limb salvage rates didn’t differ between the two groups.

The Safety and Efficacy of Different Endovascular Treatments for In-Stent Restenosis of the Femoropopliteal Artery: A Network Meta-analysis

Review of the MEDLINE, Embase, Web of Science, and Cochrane databases through February 1, 2021. There were 1348 patients from 14 eligible studies (10 prospective, randomized; 4 retrospective) with femoropopliteal artery in-stent restenosis (FP-ISR) who underwent plain old balloon angioplasty (POBA), drug-coated balloon angioplasty (DCBA), peripheral cutting balloon angioplasty, Viabahn endoprosthesis, directional atherectomy, excimer laser atherectomy, and combination therapy. Technical success rates were significantly higher for Viabahn endoprosthesis than for DCBA and POBA alone. The 1-year primary patency rates were significantly higher for excimer laser atherectomy plus DCBA than excimer laser atherectomy plus POBA and POBA alone. Excimer laser atherectomy plus DCB showed encouraging results regarding one-year primary patency rates for femoropopliteal in-stent restenosis.

One-Year Outcomes of Two Different Paclitaxel-Eluting Stents (Zilver PTX and Eluvia) for Trans-Atlantic Inter-Society Consensus Document (TASC) C/D Obstructive Femoropopliteal Lesions

Background: Endovascular therapy is one of the standard treatment options for patients with peripheral arterial disease. Paclitaxel-eluting stents (PES) have shown promising results in the treatment of obstructive femoropopliteal lesions. Two types of PES, namely, Zilver PTX (Cook Medical, USA) and Eluvia (Boston Scientific, USA), are available worldwide. However, no study has yet compared the outcomes of applying both PES types in the real world. Objectives: This study aimed to assess the one-year outcomes of two different types of PES for Trans-Atlantic Inter-Society Consensus Document (TASC) C/D obstructive femoropopliteal lesions following suboptimal angioplasty. Patients and Methods: This single-center, retrospective, observational study examined 37 limbs of 34 patients (30 males and four females) with the mean age of 71.9 ± 9.1 years (range, 53-90 years), who were included consecutively from February 2017 to May 2018. In all patients, either a Zilver PTX (Cook Medical) or an Eluvia (Boston Scientific) PES was used for TASC C/D obstructive femoropopliteal lesions following suboptimal angioplasty. Moreover, the patients’ one-year primary patency rate, freedom from clinically driven target lesion revascularization (TLR), and event-free survival rates were determined. Results: The mean lesion length was measured to be 24.6 ± 6.6 cm (range, 9 - 46 cm). Based on the results, 78% of the lesions (29 limbs) showed occlusion, and 46% (17 limbs) showed more than moderate calcification. According to the TASC classification, type D lesions were detected in 25 (68%) limbs, while type C lesions were detected in 12 (32%) limbs. The mean number of stents used was 2.5 ± 0.7 per limb (range, 1 - 3) to cover a mean length of 24.3 ± 7.9 cm (range, 6-35 cm). Overall, 56 Zilver PTX stents for 23 limbs and 36 Eluvia stents for 14 limbs were used. The Kaplan-Meier estimates of one-year primary patency and freedom from TLR were 78% and 88%, respectively (Zilver PTX stent, 76.3% and 81.2%, respectively; Eluvia stent, 91.7% and 100%, respectively). Major adverse events were reported in two patients (2/37, 5.4%), including acute thrombotic occlusion of the treated lesions. Conclusion: Both types of PES showed promising one-year outcomes for TASC C/D lesions regarding safety and efficacy, without any significant differences; therefore, they can be considered as an alternative therapeutic approach for surgery.

Outcomes of arteriovenous fistula for hemodialysis in pediatric age group

IntroductionThe feasibility of arteriovenous fistula (AVF) creation in pediatric patients has long been documented, but few studies have evaluated the forms and long-term outcomes. The aim of this article is to highlight the types, techniques and outcomes of AVFs in pediatric age group. MethodsThis is multi-center, retrospective, single cohort study, including all the cases of pediatric (less than 18 year old) cases underwent AVF creation during four years (2015–2019). The following data were obtained from the patients' medical records and analyzed; socio-demographics, etiology of renal failure (RF), history of dialysis and transplantation, type and site of AVF, the outcomes and complications. ResultsThe study included 108 patients, 89 patients (82.4%) were female. The mean age was 13 years. The most common cause of RF was the urological causes which were found in 34 cases (31.5%), followed by nephrotic syndrome (32 cases, 29.6%), glomerulonephritis (27 cases, 25%), and polycystic kidney disease (12 cases, 11.1%). The decision for choosing access site was performed only by clinical examination in 96 patients (88.9%) while duplex ultrasound was requested for 12 cases (11.1%). The operation was done under local anesthesia in 81 cases (75%) and general anesthesia in 27 cases (25%). The procedure was performed in the wrist in 58 cases (53.7%) and in cubital fossa in 50 cases (46.2%). The most common early complication was hematoma (12 cases, 11.1%), followed by ecchymosis (10 cases, 9.3%), infection (8, 7.4%), seroma (4, 3.7%) and thrombosis (3, 2.8%). The one-year primary patency rate was found in 95 patients (88%) and two-year patency rate in 86 patients (79.6%). ConclusionNative AVF in pediatric is the first choice dialysis access even in pediatric population. Radiocephalic in the non-dominant hand is the most preferred site.

Long-Term Outcomes of the Flixene Vascular Graft Used for Haemodialysis.

IntroductionThe Flixene™ vascular graft (Maquet-Atrium Medical, Hudson, NH) has emerged as a new generation synthetic graft, which allows for early needling for haemodialysis. Most studies have shown satisfactory early results. The aim of this study is to report on long-term outcomes of the Flixene graft over eight years in a cohort of patients.MethodsFrom February 2011 to September 2019, 61 patients had 64 arteriovenous graft fistulas (AVGs) by using the Flixene grafts. The median patient age was 67 years; the male to female ratio was 30:31. Diabetes was the reason for the majority of kidney failures (57%). The configuration of the grafts used was mostly upper arm straight AVG. The primary patency rate, secondary patency rate, and surgical complications were assessed.ResultsIn a median follow-up of three years (interquartile range (IQR): 2 - 6), 36 of the AVGs required a fistulogram. Venous side stenosis was the most common cause of high venous pressure or AVG occlusion in 97%. The one-year primary patency rate was 30%. The secondary patency rate was 94.8%, 83.7%, and 77.7% at one, three, and five years, respectively. The longest functional AVG was observed for up to seven years.ConclusionsThis study has shown satisfactory long-term results of the Flixene graft used for hemodialysis. The Flixene graft could be needled within 72 hours without increased complications, which allows the creation of an AVG under an emergency setting to avoid the placement of a central venous catheter (CVC). This strategy should be advocated in future clinical practice.

Endovascular management of unilateral common iliac artery ostial occlusive disease; bilateral kissing stents, unilateral stent with contralateral supporting balloon or unilateral stent with contralateral safety wire; comparative study

Aim To evaluate the safety, early, and short-term efficacy of kissing stents, unilateral common iliac artery (CIA) stent with contralateral supporting balloon, and unilateral CIA stent with contralateral safety wire in patients with symptomatic unilateral CIA ostial occlusive disease. Patients and methods This prospective study was carried out from April 2016 to November 2019 at 6 October Insurance Hospital, Cairo, and Sohag University Hospitals on 79 patients complaining of de novo unilateral CIA ostial occlusive disease, Rutherford category 3, 4, and 5, who were divided randomly into three groups to be treated endovascularly by bilateral kissing stent technique (group A), unilateral CIA stent in affected side associated with supporting balloon in the contralateral CIA (group B), or unilateral CIA stent in affected side associated with a safety wire in the contralateral CIA (group C). Patients were scheduled to be evaluated and followed up for 1 year. Results Technical success rate was 100, 87, and 67.9 in groups A, B, and C, respectively (P=0.006). One-year primary patency rate was 91.7, 90.9, and 87.5% in groups A, B, and C, respectively (P=0.998). A total of seven (9.3%) patients developed significant stenosis. Of the seven patients, and three continued medically, as they were claudicant; three cases were treated by drug-coated balloon angioplasty, and one patient by aortofemoral bypass. Plaque shift incidence was 4.3 and 14.3% in groups B and C, respectively (P=0.095). Distal embolization occurred in the contralateral side in 8.7 and 17.9% in groups B and C, respectively (P=0.083). Conclusion Kissing stent technique for treatment of unilateral ostial CIA occlusive disease achieves excellent technical success with minimal early and short-term procedure-related complications compared with unilateral stent with contralateral supporting balloon or unilateral stent with contralateral safety wire.

Endovascular thrombectomy versus open surgical thrombectomy for thrombosed arteriovenous hemodialysis graft

Objective: The aim of this study was to investigate the procedure success rate, one-year primary patency rate, one-year secondary patency rate, and complications compared between endovascular therapy and open surgical thrombectomy for treatment of thrombosed arteriovenous hemodialysis graft.Methods: This retrospective chart review included patients with thrombosed arteriovenous hemodialysis graft who were treated at the Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand during January 2012 to December 2016. Demographic, graft type, time before treatment, thrombus removal technique, additional technique, procedure success rate, operative, primary and secondary patency, follow-up time, and complication data were collected.Results: Seventy-four thrombosed dialysis grafts were included. Twenty-five and 49 grafts underwent endovascular therapy and open surgical thrombectomy, respectively. There was no significant difference in demographic data, graft type, or adjunct procedure between groups. The procedure success rate was 92% and 98% in the endovascular group and thrombectomy group, respectively (p=0.262). The one-year primary patency rate was 26% in the endovascular group, and 33% in the thrombectomy group (p=0.054). One-year secondary patency rate was 82.6% in the endovascular group, and 56.3% in the thrombectomy group (p=0.122).Conclusion: No significant differences were observed between groups for procedure success rate or 1-year primary patency rate; however, the one-year secondary patency rate in the endovascular group was significantly better than in the thrombectomy group. No difference in complications was observed between groups.

Hepatic artery occlusion in liver transplantation: What counts more, the type of reconstruction or the severity of the recipient's disease?

Although the type of hepatic artery revascularization technique is known to have an impact on patency rates, independent perioperative risk factors on patient outcomes are poorly defined. All consecutive adult patients undergoing cadaveric liver transplantation (n = 361) from July 2007 to June 2016 in a single institution were analyzed. Primary outcomes were early (<30 days) hepatic artery occlusion and primary hepatic artery patency rate. A multivariate model was used to identify independent risk factors for occlusion and the need of arterial conduit, as well as their impact on graft and patient survival. Arterial revascularization without additional reconstruction (end-to-end arterial anastomosis [AA]) was performed in 77% (n = 279), arterial reconstruction (AR) in 15% (n = 53), and aortohepatic conduit (AHC) in 8% (n = 29) of patients. AHC had the highest mean intraoperative flow (275 mL/minute; P = 0.02) compared with AA (250 mL/minute) and AR (200 mL/minute; P = 0.02). There were 43 recipients (12%) who had an occlusive event with successful revascularization in 20 (47%) recipients. One-year primary patency rates of AA, AR, and AHC were 97%, 88%, and 74%, respectively. Aortic calcification had an impact on early occlusion. AR (odds ratio [OR], 3.68; 95% confidence interval [CI], 1.26-10.75; P = 0.02) and AHC (OR, 6.21; 95% CI, 2.02-18.87; P = 0.001) were independent risk factors for early occlusion. Dyslipidemia additionally independently contributed to early occlusion (OR, 2.74; 95% CI, 0.96-7.87; P = 0.06). The 1- and 5-year graft survival rates were 83% and 70% for AA, 75% and 69% for AR, and 59% and 50% for AHC (P = 0.004), respectively. In conclusion, arterial patency is primarily determined by the type of vascular reconstruction rather than patient or disease characteristics. The preoperative lipid status is an independent risk factor for early occlusion, whereas overall occlusion is only based on the performed vascular reconstruction, which is also associated with reduced graft and patient survival. Liver Transplantation 24 790-802 2018 AASLD.

Single-session Aspiration Thrombectomy of Lower Extremity Deep Vein Thrombosis Using Large-size Catheter without Pharmacologic Thrombolysis

To retrospectively evaluate the efficacy of single-session aspiration thrombectomy using large catheters without pharmacologic thrombolysis to treat acute and subacute lower extremity deep vein thrombosis (DVT). From January 2008 to December 2011, single-session aspiration thrombectomy using large, 11F introducer catheters to treat acute and subacute lower extremity DVT was performed in 74 limbs of 74 patients (M/F = 23/51, age range 36-88 years), and clinical and imaging follow-up of over 6 months were obtained in 26 patients. Causes of DVT were May-Thurner syndrome (n = 65), malignancy related (n = 6), and pelvic mass (n = 3). A 14F introducer sheath was inserted through the popliteal vein, followed by rotational thrombus maceration and aspiration thrombectomy. Angioplasty and stent placement were performed when needed. Radiological images and medical records were reviewed for immediate and midterm results, complications, and recurrences. Initial technical success rate was 89.2% (66 patients). Stenting was performed in 55 patients. The failures were due to underlying chronic thrombi/DVT (n = 7) and stent failure due to huge pelvic mass (n = 1). There was no procedure-related complication. In the 26 midterm follow-up patients for a duration of 6-48 months, there was no recurrence (n = 20), stent occlusion (n = 3), or femoral vein occlusion (n = 3). One-year primary patency rate in stent/iliac vein, femoral vein, and popliteal/infrapopliteal vein were 88.5, 88.5, and 96.2%, respectively. Single-session aspiration thrombectomy for acute and subacute lower extremity DVT using large introducer catheters without pharmacologic thrombolysis is feasible with acceptable immediate and midterm results, excluding complications related to pharmacologic thrombolysis.

Stent-grafts versus angioplasty and/or bare metal stents for failing arteriovenous grafts: a cross-over longitudinal study

A well-established method to preserve failing synthetic arteriovenous grafts (AVGs) dialysis accesses is percutaneous transluminal angioplasty (PTA). Nevertheless, the one-year primary patency rate following PTA is approximately 25%. This study was designed to compare the angiographic and clinical outcomes following stent-graft insertion versus angioplasty and/or bare metal stenting (BMS) of recurrently failing AVGs, because of anastomotic and/or venous outflow stenoses. Self-expanding stent-grafts were deployed for the treatment of failing AVGs in case of recurrent stenosis after treatment with conventional angioplasty or bail-out BMS. Regular angiographic follow-up was scheduled every two months the first six months and every three months thereafter. Data from previous procedures on the same treatment site were retrieved from our database. Primary patency was defined as a functioning graft with a patent treatment site without angiographic restenosis >50% and without any subsequent repeat procedures. Outcome data were analyzed by Kaplan-Meier analysis. In total, 35 patients previously treated with angioplasty and/or BMS for the treatment of recurrent significant AVG stenosis (group PTA), underwent stent-graft placement of the same treatment site (group SG). Of those, 20 patients had undergone angioplasty and 15 bail-out BMS. Mean lesion length was 4.8±1.7cm. Primary patency was significantly improved in the SG group (Hazard Ratio [HR] = 0.2 [95% CI= 0.11-0.36], P=.0001) by log-rank test. The estimated six and 12-month patency rates were 76.9% vs. 25.7%, and 61.4% vs. 8.6% for groups SG and PTA respectively, (P<.0001). Stent-graft placement significantly improves primary patency of anastomotic and venous outflow stenoses in recurrently failing prosthetic arteriovenous grafts.

Is Femorofemoral Crossover Bypass an Option in Claudication?

Since the introduction of femorofemoral crossover bypass by Freeman and Leeds in 1952 (Calif Med 1952;77:229-233), it has been used as an alternative to anatomic surgical reconstruction for unilateral iliac disease. The objective of this review was to summarize results on femorofemoral crossover bypass surgery for disabling claudication from the most recent studies. All publications describing series or registries of patients treated for claudication by femorofemoral crossover bypass were sought through computerized searches of MEDLINE database. Main outcome measures considered for comparisons were primary and secondary patency rates; mortality; complications such as infection, amputation, or loss of function; improving walking distance or ankle-brachial index; Quality of Life (QoL) variations. Six studies met the inclusion criteria. In the considered series, primary interventions were performed with Dacron, polytetrafluoroethylene (PTFE) or autologous vein graft. The number of patients treated for claudication ranged from 66 to 211 in the considered series. One-year primary patency rates ranged from 71.6 to 96%. In two series, 5-year primary patency rates reported were 71.8 and 72%, and in one series secondary patency rate at 5 years was 89%. The femorofemoral crossover bypass in patients with disabling claudication caused by unilateral iliac artery disease is still a valuable alternative to aortofemoral grafting in those who are not suitable for endovascular repair or major abdominal surgery, or have poor general (age, coronary artery disease, chronic obstructive pulmonary disease (COPD), etc.) or local (hostile abdomen, sepsis, porcelain aorta) conditions, presenting in recent series with good long-term patency and low complication rates.

Results of a Multicenter Trial for the Treatment of Traumatic Vascular Injury with a Covered Stent

The safety and efficacy of endovascular treatment of arterial trauma using the Wallgraft Endoprosthesis was evaluated in a subgroup analysis of a prospective, multicenter, nonrandomized registry trial with a historical control to surgical management. Endpoints were exclusion success at procedure and at 12-months, primary patency and freedom-from-bypass at 12-months, and major adverse events. Sixty-two patients were treated for arterial trauma from October 1997 to June 2003. The anatomic locations of the injuries were: iliac (33), subclavian (18), and femoral (11) arteries. Indication for treatment was perforation/rupture (33), acute pseudoaneurysm (10), AV fistula (16), and dissection (3). Exclusion and patency were assessed using arteriography, duplex ultrasound, CT, or MRA at postprocedure and 12-months. Major adverse event and mortality rates were compared with surgical intervention of arterial trauma using literature based objective performance criteria. The Wallgraft Endoprosthesis achieved postprocedure exclusion in 58 of 62 cases (93.5%). One-year exclusion rates were 91.3% iliac, 90.0% subclavian, and 62.3% femoral. One-year primary patency rates were 76.4% iliac, 85.7% subclavian, and 85.7% femoral. Freedom-from-bypass was achieved in 74.3% iliac and 100% femoral and subclavian injuries. The most common adverse events were stenosis (4.8%) and occlusion (6.5% early, 1.6% late). There were no device- or procedure-related deaths. Analysis of the literature revealed the rates and severity of complications are less than those associated with surgical repair. The Wallgraft Endoprosthesis for the treatment of traumatic arterial injuries offers a promising alternative to conventional operative repair with comparable patency and less major morbidity and mortality.

Improved clinical outcome with transjugular intrahepatic portosystemic stent-shunt utilizing polytetrafluoroethylene-covered stents

Transjugular intrahepatic portosystemic stent-shunt (TIPSS) with standard uncovered stents has a 50% one-year primary patency rate, and is complicated by hepatic encephalopathy in 35% of patients. Newer covered stents appear to have improved patency. This large study aimed to assess the shunt function and clinical efficacy of polytetrafluoroethylene-covered stents in a single centre. A total of 316 patients with uncovered stents before the introduction of covered stents (group 1) and 157 patients with the Viatorr Gore polytetrafluoroethylene-covered stents at the time of TIPSS creation (group 2) were studied. The mean follow-up was 22.8+/-25.4 and 13.1+/-12.5 months, respectively (P<0.01). Shunt insufficiency was greater in group 1 [54 versus 8% at 12 months; relative hazard (RH) 8.6; 95% confidence interval (CI) 4.8-15.5; P<0.001]. The incidence of variceal rebleeding was greater in group 1 (11 versus 6% at 12 months; RH 2.4; 95% CI 1.1-5.1; P<0.05). The incidence of hepatic encephalopathy was greater in group 1 (32 versus 22% at 12 months; RH 1.5; 95% CI 1.1-2.3; P<0.05). Mortality was similar in the two groups. The Viatorr type of polytetrafluoroethylene-covered stent results in vastly improved patency compared with uncovered stents, with reduced rates of variceal rebleeding and hepatic encephalopathy. This type of covered stent has the potential for superior clinical efficacy compared with uncovered stents.

The role of interventional radiology in management of patients with end-stage renal disease

The aim of the paper is to review the role of interventional radiology in the management of hemodialysis vascular access and complications in renal transplantation. The evaluation of patients with hemodialysis vascular access is complex. It includes the radiology/ultrasound (US) evaluation of the peripheral veins of the upper extremities with venous mapping and the evaluation of the central vein prior to the access placement and radiological detection and treatment of the stenosis and thrombosis in misfunctional dialysis fistulas. Preoperative screening enables the identification of a suitable vessel to create a hemodynamically-sound dialysis fistula. Clinical and radiological detection of the hemodynamically significant stenosis or occlusion demands fistulography and endovascular treatment. Endovascular prophylactic dilatation of stenosis greater than 50% with associated clinical abnormalities such as flow-rate reduction is warranted to prolong access patency. The technical success rates are over 90% for dilatation. One-year primary patency rate in forearm fistula is 51%, versus graft 40%. Stents are placed only in selected cases; routinely in central vein after dilatation, in ruptured vein and elastic recoil. Thrombosed fistula and grafts can be declotted by purely mechanical methods or in combination with a lytic drug. The success rate of the technique is 89–90%. Primary patency rate is 8–26% per year and secondary 75% per year. The most frequently radiologically evaluated and treated complications in renal transplantation are perirenal and renal fluid collection and abnormalities of the vasculature and collecting system. US is often the method of choice for the diagnostic evaluation and management of the percutaneous therapeutic procedures in early and late transplantation complications. Computed tomography and magnetic resonance are valuable alternatives when US is inconclusive. Renal and perirenal fluid collection are usually treated successfully with percutaneous drainage. Doppler US, magnetic resonance angiography and digital subtraction angiography have a principle role in the evaluation of vascular complications of renal transplantation and management of the endovascular therapy. Stenosis, the most common vascular complication, occurs in 1–12% of transplanted renal arteries and represents a potentially curable cause of hypertension following transplantation and/or renal dysfunction. Treatment with percutaneous transluminal renal angioplasty (PTRA) or PTRA with stent has been technically successful in 82–92% of the cases, and graft salvage rate has ranged from 80 to 100%. Restenosis occurs in up to 20% of cases, but are usually amenable to repeated PTRA. Complications such as arterial and vein thrombosis are uncommon. Intrarenal A/V fistulas and pseudoaneurysms are occasionally seen after biopsy, the treatment requires superselective embolisation. Urologic complications are relatively uncommon, predominantly they consist of the urinary leaks and urethral obstruction. Interventional treatment consists of percutaneous nephrostomy, balloon dilation, insertion of the double J stents, metallic stent placement and external drainage of the extrarenal collections.

Upper Arm Arteriovenous Fistulas as a Reliable Access Alternative for Patients Requiring Chronic Hemodialysis

The wrist fistula is the access procedure of choice in the hemodialysis patient. However, unavailable or unusable anatomy in this aging population has made them difficult to establish. This study retrospectively compares patency, occlusion, and complication rates of upper arm arteriovenous fistulas (AVFs) as a reliable alternative. Fifty-eight upper arm AVFs were created in 52 patients between February 1995 and August 1997 at Hermann Hospital, affiliated with the University of Texas Health Science Center in Houston, Texas. Fistulas were constructed using the brachial artery (BA) side-to-end (n = 56) or side-to-side (n = 1) with either the cephalic vein (CV; n = 39), transposed basilic vein (TBV; n = 16), or other vein [basilic vein (BV; n = 1), transposed cephalic vein (TCV; n = 1), median cubital vein (MCV; n = 1)]. One-year primary patency rates for upper arm AVFs were 66 per cent, and secondary patency rates were 22 per cent. Flow rates averaged 354.6 mL/minute. Primary and secondary patency rates for fistulas created are: BA-CV (67% and 20%), BA-TBV (63% and 25%), and other upper arm AVFs 66 per cent without revisions. Primary patencies for both BA-CV and BA-TBV fistulas were similar to previously reported studies. Secondary patencies proved to be less effective. Upper arm AVFs should be considered before graft placement when wrist and forearm anatomy does not lend itself to fistula creation.

Is Balloon Angioplasty Indicated for “Short” Stenoses of Failing Vein Grafts?

Previous reports have suggested "short" focal stenoses in peripheral vein grafts (PVGs), namely less than 2 cm long, can be successfully balloon dilated with good long-term patency rates. We questioned if enthusiasm for balloon angioplasty of these lesions in failing PVGs is warranted. Between August 1, 1993 and December 31, 1996, we performed balloon angioplasty of "short" stenoses in 19 PVGs in 16 patients. Bypasses included seven femoropopliteal, six femorotibial, and six popliteal-tibial or -pedal PVGs. All bypasses were originally performed for limb salvage. Single lesions were present in 13 grafts and two lesions in six grafts. Ten lesions were located at an anastomosis, 10 were located in the body of the graft, and five were peri-anastomotic. Fifteen procedures were performed percutaneously. Four angioplasties were performed using an open surgical approach because a percutaneous attempt failed in one case and three grafts were either in situ or tunneled subcutaneously making them easy to expose. Completion arteriogram documented excellent initial results in all 19 grafts. Cumulative one-year primary patency rate was 39%. The assisted primary patency rate at one year was 73%. Only five grafts remained patent 7-20 months (mean, 10 months) during follow-up without requiring further revision. One patient died with a patent graft 23 months post-balloon angioplasty. Complications included two hematomas following a percutaneous approach that required surgical repair. These results when compared to publications detailing patency following surgical revision suggest that balloon angioplasty of "short" stenoses less than 2 cm long in PVGs may be better treated by surgical revision. We reserve balloon angioplasty for "short" lesions when surgical revision is associated with inordinate difficulty such as a scarred groin wound in an obese patient.