Percutaneous approach in the maintenance and salvage of dysfunctional autologous vascular access for dialysis

被引:4
作者
De Rango, Paola
Parente, Basso
Cieri, Enrico
Bonanno, Paolo
Farchioni, Luca
Manzone, Alessandra
Verzini, Fabio
机构
[1] Hosp SM Misericordia, Unit Vasc & Endovasc Surg, Perugia, Italy
[2] Univ Perugia, I-06100 Perugia, Italy
关键词
Angioplasty; Balloon; Maintenance; Vascular access; ARTERIOVENOUS HEMODIALYSIS ACCESS; BALLOON ANGIOPLASTY; PRACTICE GUIDELINES; GRAFTS; PLACEMENT; PRESSURE; STENOSES; FISTULAS; SOCIETY;
D O I
10.5301/jva.5000060
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
Purpose: Endovascular procedures have been increasingly used for salvage of failing vascular access with conflicting results. The aim of this study was to assess the mid-term patency and complication rates of angioplasty procedures performed in a single center for treatment of stenosis compromising vascular accesses. Methods: A prospective database of vascular accesses performed in 2006-2010 was investigated. The endovascular approach was applied following a standardized protocol by a dedicated team. A total of 531 consecutive procedures were reviewed (326 men; mean age 70.94 years). Patency rates were estimated using the Kaplan-Meier method. Results: There were 199 procedures for failing access: 135 were surgical and 64 angioplasties performed for anastomosis (n=27), venous (n=45) or arterial (n=7) stenosis. Immediate technical success of endovascular procedures was 95.3%(61/64); complication rate was 6.3% (4/64). Primary patency rates were 55% at six months, 49% at 12 months, and 21% at 24 months. In the concurrent group of 135 open procedures, primary patency rates were 80% at six months and 67% at 12 months (P=.002); nevertheless, at 24 months, patency was as low as 49%. Cost estimates for angioplasty revealed additional fees ranging from 411.34 to 446.34 Euro with respect to open surgical procedures. Conclusions: Most dysfunctional vascular accesses can be successfully and safely treated by the endovascular route. In spite of poor mid-term durability, the angioplasty balloon might be considered as a bridge, effective, and repeatable solution with reasonable costs to prolong access survival avoiding additional surgery. The failure rate in the mid-term for dysfunctional vascular access may also be high after surgical reintervention.
引用
收藏
页码:381 / 387
页数:7
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