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Introduction. The arteriovenous fistula (AVF) dysfunction is a common reason for vascular access problem in chronically hemodialyzed patients. It is caused by stenosis or occlusion located either in inflow artery, anastomosis or outflow vein. Revascularization of these pathologies can be achieved in surgical or endovascular (PTA) manner. The aim of this study was to evaluate both immediate and late endovascular treatment results of dysfunctional fistulas in chronically hemodialyzed patients. Material and methods. We included in our observation 106 patients with end stage renal disease, who underwent PTA within arteriovenous fistulas. We used conventional and unified techniques of endovascular therapy. Procedural results were evaluated after 1, 3, 6 and 12 months based on fistula sufficiency during hemodialysis. Results. In 96 (90.6%) cases the initial result of PTA was good. We achieved improvement in blood flow through AVF and successful hemodialysis. In 10 cases (9.4%) results were not satisfactory. None of our patients developed neither worsening in the blood flow through AVF nor compromised blood circulation distally to AVF. No serious complications (MI, stroke, death) occurred during procedure or hospital stay. After 12 months, in 52 patients AVF were functioning properly. In 20 cases, because of fistula dysfunction, reintervention was necessary (primary patency 66%). Considering all patients, also these with successful reintervention, 69 AVF were functioning properly after 12 months (secondary patency 86%). Conclusions. To conclude, the immediate and long-term PTA outcomes of arteriovenous fistulas with currently available techniques and equipment are satisfying. PTA is a safe manner of prolonging patency rate of AVF in patients requiring permanent hemodialysis. [ABSTRACT FROM AUTHOR]

Background: To provide data on safety and immediate effects of endovascular treatment of PAOD which may be used to work out the best approach to invasive treatment of this disease in our country. Material and methods: All data were collected prospectively in the Malopolska Endovascular Registry. There were 763 procedures performed between Dec. 1, 2009 and June 31, 2010. The indication for treatment was leg ischemia Rutherford stage 6 in 77 cases (10.1%), stage 5 in 173 cases (22.7%), stage 4 in 123 cases (16.1%), stage 3 in 371 cases (48.6%) and stage 2 in 19 cases (2.5%). Results: Overall, an increase in blood supply to the treated leg was seen in 97.5% of procedures while deterioration was noted in only 0.5% of cases. The worst results were obtained in the procedures performed on infrapopliteal vessels -- there was a 4.6% rate of bad results (defined as no increase in blood flow or a deterioration of flow to the treated leg upon completion of endovascular treatment). Major complications were seen in 0.8% of procedures: 1 ischemic stroke, 2 acute coronary syndromes were noted, one patient was emergently operated on due to stent misplacement and 2 patients developed acute pulmonary edema. There were no deaths and no amputations. Moderate severity complications were seen in 3.7% of procedures and mild complications in 16.6%. The frequency of complications was significantly greater in CLI patients in comparison to non-CLI patients, but the number of severe and moderate severity complications was quite low. Conclusions: Endovascular treatment of PAOD is safe and the immediate results are very good. The referral of claudicants for endovascular treatment may be justified provided the long term effects of percutaneous treatment are favorable. Comparison with the results of surgical therapy may serve to work out the best treatment strategy of patients with chronic lower leg ischemia. [ABSTRACT FROM AUTHOR]

Background: Critical limb ischemia (CLI) has an ominous prognosis. Effective revascularization saves the limb, improves the quality of life and is cost-effective. While bypass surgery has dominated treatment for decades it can be offered to a limited subset of patients. Endovascular treatment is an alternative method of revascularization. The aim of the study was to assess mid-term results of percutaneous balloon angioplasty in patients with CLI and severe obstructive lesions in below-the-knee arteries. Material and methods: This was an open, prospective 1-year observation of 120 CLI patients in whom 127 limbs were treated. The majority of patients were in Rutherford class 6, the minority in Rutherford class 4. Results: After 12 months 52 patients were still alive, did not present signs or symptoms of CLI and had the treated limb preserved (43%). 19 patients had died (16%) and there were 25 amputations (20%). However, the periprocedural complication rate was high (14%), with most of the complications being related to arterial puncture. Conclusions: Percutaneous revascularization is justified in CLI patients with below-the-knee obstructive lesions not amenable to surgery. After one year, the results of endovascular treatment are far better than the reported results of conservative treatment. Modifications in endovascular procedure techniques may improve final results. [ABSTRACT FROM AUTHOR]

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