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Predictors of primary patency after percutaneous balloon angioplasty for stenosis of Brescia-Cimino hemodialysis arteriovenous fistula
- Source :
- Br J Radiol
- Publication Year :
- 2020
- Publisher :
- British Institute of Radiology, 2020.
-
Abstract
- Objective: Percutaneous transluminal balloon angioplasty (PTA) is recommended as the first choice to treat stenosis of Brescia-Cimino arteriovenous fistulas (B-C AVFs). The ability to predict which B-C AVFs are at risk for recurrent stenosis post-PTA would allow closer monitoring of patients, and possibly result in surgical intervention rather than repeat PTA. The purpose of this study was to identify predictive factors of primary patency after PTA in B-C AVFs. Methods: Patients diagnosed with B-C AVF primary stenosis and treated by PTA between November 2013 and March 2018 were included in the study. Patient and stenotic lesion characteristics and PTA procedure factors were included in the analysis. The Kaplan–Meier method was used to analyze the primary patency rate. Cox proportional hazard regression analysis was used to identify factors predictive of decreased primary patency. Results: 74 patients (35 males, 39 females) with a mean age of 61.68 ± 11.44 years (range, 36–84 years) were included in the study. The mean B-C AVF age was 16.34 ± 12.93 months (range, 2–84 months), and the median primary patency time was 7.79 ± 0.48 months. Cox proportional hazard regression analysis revealed stenosis location at the inflow artery [hazard ratio (HR)=3.83, 95% confidence interval (CI): 1.46–10.09] or anastomosis (HR = 1.90, 95% CI: 1.09–3.32), dilation >2 times during PTA (HR = 2.30, 95% CI: 1.22–4.34), and residual stenosis >30% (HR = 2.42, 95% CI: 1.26–4.63) were significantly associated with decreased patency. Conclusion: In conclusion, the primary patency rate of PTA for B-C AVF dysfunction is reduced by dilation >2 times, residual stenosis >30%, and stenosis located at the inflow artery or anastomosis. These results may help in tailoring surveillance programs, multiple PTA, or a proximal re-anastomosis surgery in patients with AVF dysfunction. Advances in knowledge: A number of studies have been conducted to examine the predictors of primary patency after PTA, however, no definitive conclusions have been reached. Our study revealed that stenosis location at the inflow artery or anastomosis, dilation >2 times during PTA, and residual stenosis >30% were the predictors of primary patency after PTA, which may help in tailoring surveillance programs, multiple PTA, or a proximal re-anastomosis surgery in patients with arteriovenous fistulas dysfunction.
- Subjects :
- Adult
Male
medicine.medical_specialty
medicine.medical_treatment
Treatment outcome
Constriction, Pathologic
030204 cardiovascular system & hematology
Percutaneous transluminal balloon angioplasty
030218 nuclear medicine & medical imaging
Constriction
03 medical and health sciences
Arteriovenous Shunt, Surgical
0302 clinical medicine
Renal Dialysis
Angioplasty
medicine
Humans
Radiology, Nuclear Medicine and imaging
Vascular Patency
Aged
Aged, 80 and over
Full Paper
business.industry
Endovascular Procedures
Graft Occlusion, Vascular
Percutaneous balloon angioplasty
General Medicine
Middle Aged
medicine.disease
Surgery
Stenosis
Equipment failure
Treatment Outcome
Equipment Failure
Female
Hemodialysis - arteriovenous fistula
business
Angioplasty, Balloon
Subjects
Details
- ISSN :
- 1748880X and 00071285
- Volume :
- 93
- Database :
- OpenAIRE
- Journal :
- The British Journal of Radiology
- Accession number :
- edsair.doi.dedup.....668b01f000f8bd3a912dab5cd61277a4
- Full Text :
- https://doi.org/10.1259/bjr.20190505