ABSTRACT
BACKGROUND: Achieving well-functioning dialysis fistulas is a common problem in dialyzed patients, and it is mainly caused by the pathologies of vessels used for fistula creation. Hybrid therapies, combining surgical and endovascular procedures, potentially enable the creation of functional dialysis fistulas in patients with vessels that are otherwise unsuitable for vascular access. METHODS: Between January 1, 2014 and June 30, 2018, we created dialysis fistulas simultaneously with endovascular correction of outflow pathologies in 15 patients. The included patients had a long history of dialysis (median 10.5 years, range 3-22) and many previous dialysis access procedures (mean 5.3 procedures, range 2-9). In 13 patients (86.7%), the fistula was created on the upper arm; in 5 patients (33.3%), it was arteriovenous graft done with polytetrafluoroethylene (PTFE) prosthesis (in an additional 3 patients, a PTFE prosthesis was used to extend the vein), and 7 patients had native vessel fistulas (46.7%). Endovascular procedures, in some cases performed on more than 1 vein, were applied for correction of the subclavian vein (8 patients, 53.3%); brachiocephalic vein (6 patients, 40.0%); cephalic, basilic, and axillary veins (2 patients each, 13.3%); and superior cava vein (1 patient, 6.7%). Access for the endovascular procedure was achieved through a dissected vein used for arteriovenous anastomosis. The fistula function was monitored, and all complications of dialysis access were noted. The median follow-up in the observed group was 18 months. We compared the patency of dialysis fistula creation combined with endovascular correction of outflow vein pathology to our results of standard dialysis fistula operations: radiocephalic dialysis fistula creation (RCAVF group, 65 patients) and dialysis fistula stenosis angioplasty (PTA group, 30 patients). RESULTS: The 12- and 24-month primary patency rates of dialysis fistulas created in hybrid procedures with simultaneous outflow vein pathology correction were 72.7% and 63.6%, respectively. No early complications related to endovascular or open procedures were observed. CONCLUSIONS: A hybrid procedure for the creation of a dialysis fistula with the simultaneous correction of outflow pathologies enables a properly functioning dialysis fistula to be obtained. This procedure can be performed in patients with complicated vascular situations, enabling the creation of dialysis fistulas. Our results of hybrid procedures, involving simultaneous endovascular correction of the outflow vein with dialysis fistula creation, showed the efficiency and good results.
Subject(s)
Angioplasty , Arteriovenous Shunt, Surgical , Blood Vessel Prosthesis Implantation , Renal Dialysis , Upper Extremity/blood supply , Vascular Diseases/therapy , Veins/surgery , Adult , Aged , Aged, 80 and over , Angioplasty/adverse effects , Angioplasty/instrumentation , Arteriovenous Shunt, Surgical/adverse effects , Arteriovenous Shunt, Surgical/instrumentation , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/instrumentation , Female , Graft Occlusion, Vascular/etiology , Graft Occlusion, Vascular/physiopathology , Graft Occlusion, Vascular/therapy , Humans , Male , Middle Aged , Risk Factors , Time Factors , Treatment Outcome , Vascular Diseases/diagnostic imaging , Vascular Diseases/etiology , Vascular Diseases/physiopathology , Vascular Patency , Veins/diagnostic imaging , Veins/physiopathologyABSTRACT
INTRODUCTION: Percutaneous endovascular angioplasty has become the treatment of choice for dialysis fistula stenosis. The ultrasound-guided endovascular procedure is used in patients with severe renal impairment and advanced renal transplant failure, when the need for nephrotoxic contrast administration in standard angioplasty may worsen renal function. AIM: To evaluate endovascular angioplasty guided by ultrasound for dialysis fistula stenosis in renal transplant patients with severe graft insufficiency. MATERIAL AND METHODS: We compared ultrasound (US)-guided angioplasty, performed in patients after renal transplantation, with standard contrast angioplasty performed in dialysis patients. We treated 10 kidney allograft recipients (9 kidneys and 1 kidney-pancreas) with significantly compromised renal transplant function and significant stenosis in dialysis fistulas, as detected during US examination. Patients were qualified for percutaneous angioplasty under US guidance. The mean period from transplantation was 32.7 months (5-100 months). Results of their treatment were compared to the control group of 20 end-stage renal disease patients with dialysis fistula stenosis treated by angioplasty under standard contrast visualization. RESULTS: The immediate effectiveness of the angioplasty was 100% in both groups. No early complications of angioplasty or problems with the guidewire crossing the stenosis were observed. Twelve months of primary patency was observed in 80% and 45% in the US-guided and control groups, respectively. CONCLUSIONS: The US-guided endovascular procedure is an effective and safe method of treating dialysis fistula stenosis in patients with impaired renal transplant function.
ABSTRACT
Endovascular procedures are commonly used for treatment of vascular pathologies. These interventions are routinely performed under angiographic control. Angioplasty is increasingly more often used for correction of dialysis fistula - especially dilatation of stenosis. We describe the technique of dialysis fistula angioplasty under ultrasound control. Benefits of this procedure include lack of nephrotoxic contrast, what is especially important in chronic kidney disease patients in pre-dialysis period. Advantages of ultrasound guidance during dialysis fistula angioplasty lead to cause more and more frequent employment of this technique.
