Management of perianastomotic stenosis of direct wrist autogenous radial-cephalic arteriovenous accesses for dialysis.

OBJECTIVE: Radial-cephalic fistulas (RCFs) perianastomotic stenoses (PASs) are on and around the fistula anastomosis. This group of lesions encompasses juxta-anastomotic stenosis (stenosis located on the venous side within 3 cm away from the anastomosis), anastomotic, and arterial stenosis. The purpose of our study was to assess the postintervention primary patency and assisted postintervention primary patency (APP) rates for surgery and angioplasty when treating these stenoses. The secondary endpoint was to identify factors that might influence the procedure's patency rates. MATERIALS AND METHODS: This retrospective study included 73 consecutive patients treated for lack of maturation PASs between January 1999 and December 2005 in two interventional centers. Patients' mean age was 65 years old. Stenoses were treated by surgery (n = 21) or percutaneous transluminal angioplasty (PTA; n = 52). Surgery meant creation of a new anastomosis excluding the area of stenosis. Preoperative characteristics including the patient's age, gender, comorbidities, stenosis location, and length were not statistically different between the two groups. The mean follow-up was 39 months for PTA and 49 months for surgery. RESULTS: Anatomical and clinical success rates were 86% and 90% for surgery, and 75% and 92% for PTA. At 1 year, the primary patency rates were 71 ± 10% for surgery and 41 ± 6% for PTA, respectively (P < .02). There was no significant difference between the two groups with respect to assisted primary patency (95% vs 92%). In the PTA group, stenosis location at the anastomosis itself was a risk factor of early recurrence (P = .047). The complication rate was similar between surgery and PTA. CONCLUSION: Our results suggest that the treatment of anastomotic stenoses should be surgical rather than endovascular. Angioplasty and surgery have shown similar results when used to treat other perianastomotic stenoses, but repeat procedures were more frequent with angioplasty.

[Vesicourethral anastomotic stricture after radical prostatectomy secondary to migration of a metal clip]. / Sténose uréthro-cervicale post prostatectomie radicale secondaire à la migration d'un clip métallique.

The frequency of vesicourethral anastomotic stricture after prostatectomy is estimated to be 14%, an average of 3 months after the operation. The authors report the cases of a 61-year-old man undergoing radical prostatectomy for localized prostate cancer. The postoperative course was marked by recurrent urinary retention and several urethrotomies failed to restore spontaneous voiding. A clip was finally visualized and removed by endoscopy. The patient has not experienced any further episodes of retention. This is the first published cases of clip migration responsible for anastomotic stricture after radical prostatectomy. This diagnosis must be considered in the case of repeated postoperative retention.