Forearm Arteriovenous Fistula Maturation Delay due to Juxta-Anastomotic Stenosis: Role of Percutaneous Angioplasty
Introduction: Arteriovenous fistula is the optimal vascular access for hemodialysis as it has the best long-term patency rate and the lowest complication rate. Although we are still lacking consensus, surgery has been advocated as the best treatment option for maturation delay. We proposed to eval...
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| Format: | Article |
| Language: | English |
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Publicações Ciência e Vida
2022-06-01
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| Series: | Revista Portuguesa de Nefrologia e Hipertensão |
| Subjects: | |
| Online Access: | https://cdn02.spnefro.pt/pjnh/84/10Nefro362ORIGINAL1.pdf |
| _version_ | 1828398819338878976 |
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| author | Rui Filipe Nogueira Nuno Afonso Oliveira Emanuel Ferreira Luís Rodrigues Helena Pinto Ana Belmira Rui Alves |
| author_facet | Rui Filipe Nogueira Nuno Afonso Oliveira Emanuel Ferreira Luís Rodrigues Helena Pinto Ana Belmira Rui Alves |
| author_sort | Rui Filipe Nogueira |
| collection | DOAJ |
| description | Introduction: Arteriovenous fistula is the optimal vascular access for hemodialysis as it has the best long-term patency rate and the lowest
complication rate. Although we are still lacking consensus, surgery has been advocated as the best treatment option for maturation delay. We
proposed to evaluate the results of endovascular approach of arteriovenous fistula’s maturation delay in our hospital.
Methods: We conducted a retrospective study, selecting patients referred to our diagnostic and therapeutic angiography unit due to arteriovenous fistula delayed maturation, between April 2017 and June 2020.
Results: Thirty-four patients were referred to our center due to maturation delay, of which six (17.7%) were excluded as the diagnosis was not confirmed and six (17.7%) because the lesions were not suitable for percutaneous angioplasty. The other 22 patients (64.7%) were subjected to percutaneous
endovascular treatment. Mean age was 67.3 ± 13.8 years. Eighteen patients (81.8%) had maturation delay due to peri-anastomotic stenosis; 12 (66.7%)
were forearm fistulas (all radio-cephalic). Mean follow-up time was 21.2 ± 11.2 months. Eleven (91.7%) fistulas were salvaged, although four (33.3%)
needed reintervention. Primary and assisted primary patencies at 6 and 12 months were 66.7% vs 91.7% and 58.3% vs 91.7%, respectively.
Conclusion: Our results point out that endovascular treatment is a good treatment option for maturation delay of forearm arteriovenous
fistulas due to juxta-anastomotic stenosis. Even though surgical treatment appears to have better primary patency, a step-by-step approach
seems to be a valid strategy, as our assisted primary patency shows. |
| first_indexed | 2024-12-10T09:08:43Z |
| format | Article |
| id | doaj.art-788fcd483b8d48c0b9bb417475cb9332 |
| institution | Directory Open Access Journal |
| issn | 0872-0169 2183-1289 |
| language | English |
| last_indexed | 2024-12-10T09:08:43Z |
| publishDate | 2022-06-01 |
| publisher | Publicações Ciência e Vida |
| record_format | Article |
| series | Revista Portuguesa de Nefrologia e Hipertensão |
| spelling | doaj.art-788fcd483b8d48c0b9bb417475cb93322022-12-22T01:55:05ZengPublicações Ciência e VidaRevista Portuguesa de Nefrologia e Hipertensão0872-01692183-12892022-06-0136210110510.32932/pjnh.2022.06.188Forearm Arteriovenous Fistula Maturation Delay due to Juxta-Anastomotic Stenosis: Role of Percutaneous AngioplastyRui Filipe Nogueira0https://orcid.org/0000-0001-8735-5952Nuno Afonso Oliveira1https://orcid.org/0000-0002-4112-9236Emanuel Ferreira2https://orcid.org/0000-0003-1320-2894Luís Rodrigues3https://orcid.org/0000-0003-0122-982XHelena Pinto4https://orcid.org/0000-0002-2223-3062Ana Belmira5https://orcid.org/0000-0002-1675-737XRui Alves6https://orcid.org/0000-0003-3922-3618Serviço de Nefrologia – Centro Hospitalar e Universitário de Coimbra, Coimbra, PortugalServiço de Nefrologia – Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina – Universidade de Coimbra, Coimbra, PortugalServiço de Nefrologia – Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina – Universidade de Coimbra, Coimbra, PortugalServiço de Nefrologia – Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina – Universidade de Coimbra, Coimbra, PortugalServiço de Nefrologia – Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina – Universidade de Coimbra, Coimbra, PortugalServiço de Nefrologia – Centro Hospitalar e Universitário de Coimbra, Coimbra, PortugalServiço de Nefrologia – Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina – Universidade de Coimbra, Coimbra, PortugalIntroduction: Arteriovenous fistula is the optimal vascular access for hemodialysis as it has the best long-term patency rate and the lowest complication rate. Although we are still lacking consensus, surgery has been advocated as the best treatment option for maturation delay. We proposed to evaluate the results of endovascular approach of arteriovenous fistula’s maturation delay in our hospital. Methods: We conducted a retrospective study, selecting patients referred to our diagnostic and therapeutic angiography unit due to arteriovenous fistula delayed maturation, between April 2017 and June 2020. Results: Thirty-four patients were referred to our center due to maturation delay, of which six (17.7%) were excluded as the diagnosis was not confirmed and six (17.7%) because the lesions were not suitable for percutaneous angioplasty. The other 22 patients (64.7%) were subjected to percutaneous endovascular treatment. Mean age was 67.3 ± 13.8 years. Eighteen patients (81.8%) had maturation delay due to peri-anastomotic stenosis; 12 (66.7%) were forearm fistulas (all radio-cephalic). Mean follow-up time was 21.2 ± 11.2 months. Eleven (91.7%) fistulas were salvaged, although four (33.3%) needed reintervention. Primary and assisted primary patencies at 6 and 12 months were 66.7% vs 91.7% and 58.3% vs 91.7%, respectively. Conclusion: Our results point out that endovascular treatment is a good treatment option for maturation delay of forearm arteriovenous fistulas due to juxta-anastomotic stenosis. Even though surgical treatment appears to have better primary patency, a step-by-step approach seems to be a valid strategy, as our assisted primary patency shows.https://cdn02.spnefro.pt/pjnh/84/10Nefro362ORIGINAL1.pdfarteriovenous fistulaendovascular proceduresrenal dialysis |
| spellingShingle | Rui Filipe Nogueira Nuno Afonso Oliveira Emanuel Ferreira Luís Rodrigues Helena Pinto Ana Belmira Rui Alves Forearm Arteriovenous Fistula Maturation Delay due to Juxta-Anastomotic Stenosis: Role of Percutaneous Angioplasty Revista Portuguesa de Nefrologia e Hipertensão arteriovenous fistula endovascular procedures renal dialysis |
| title | Forearm Arteriovenous Fistula Maturation Delay due to Juxta-Anastomotic Stenosis: Role of Percutaneous Angioplasty |
| title_full | Forearm Arteriovenous Fistula Maturation Delay due to Juxta-Anastomotic Stenosis: Role of Percutaneous Angioplasty |
| title_fullStr | Forearm Arteriovenous Fistula Maturation Delay due to Juxta-Anastomotic Stenosis: Role of Percutaneous Angioplasty |
| title_full_unstemmed | Forearm Arteriovenous Fistula Maturation Delay due to Juxta-Anastomotic Stenosis: Role of Percutaneous Angioplasty |
| title_short | Forearm Arteriovenous Fistula Maturation Delay due to Juxta-Anastomotic Stenosis: Role of Percutaneous Angioplasty |
| title_sort | forearm arteriovenous fistula maturation delay due to juxta anastomotic stenosis role of percutaneous angioplasty |
| topic | arteriovenous fistula endovascular procedures renal dialysis |
| url | https://cdn02.spnefro.pt/pjnh/84/10Nefro362ORIGINAL1.pdf |
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