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. 2019 Dec;42(12):675-683.
doi: 10.1177/0391398819863429. Epub 2019 Jul 15.

Angiography and phlebography in a hemodialysis population: A retrospective analysis of interventional results

Ursula Hadimeri  1   2 , Anna Wärme  3   4 , Salmir Nasic  5 , Sven-Göran Fransson  1   6 , Ann Wigelius  7 , Bernd Stegmayr  8
Affiliations

Angiography and phlebography in a hemodialysis population: A retrospective analysis of interventional results

Ursula Hadimeri et al. Int J Artif Organs. 2019 Dec.

Abstract

Objective: To clarify the reasons and beneficial effects and duration of arteriovenous fistula patency after radiological interventions in arteriovenous fistula. The patients investigated were referred due to arteriovenous fistula access flow problems.

Material and methods: In 174 patients, 522 radiological investigations and endovascular treatments such as percutaneous transluminal angioplasty were analyzed, retrospectively. All investigations were performed due to clinical suspicion of impaired arteriovenous fistula function.

Results: Arterial stenosis was significantly more frequent among patients with diabetic nephropathy (p < 0.001) and interstitial nephritis (p < 0.001). According to the venous stenosis, the diagnosis did not affect the frequency (p = 0.22) or the degree (p = 0.39) of stenosis. The degree of stenosis prior to percutaneous transluminal angioplasty correlated significantly with the degree of remaining stenosis after intervention (p < 0.001). Of the 174 patients, 123 (71%) performed a total of 318 investigations including percutaneous transluminal angioplasty. Repeated percutaneous transluminal angioplasty was performed significantly more often in patients with diabetic nephropathy. The median times to the first percutaneous transluminal angioplasty and to the subsequent percutaneous transluminal angioplasties were 9.5 and 5 months, respectively. Arteriovenous fistula in patients with diabetic nephropathy performed similar to most other diagnoses, although performing more percutaneous transluminal angioplasty/patient than most other diagnoses.

Conclusion: Many patients could maintain long-term patency of arteriovenous fistula, including those with diabetic nephropathy, with repeated interventions; this motivates a closer follow-up for these patients. Clinically significant stenosis should be dilated as meticulously and as soon as possible. Occlusions of the arteriovenous fistula in most instances can be successfully thrombolyzed or dilated upon early diagnosis.

Keywords: Arteriovenous fistula; angiography; fistulography; hemodialysis; percutaneous transluminal angioplasty; phlebography.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Results of 469 PTAs displayed by box plot and the median value of the remaining stenoses. The x-axis shows the degree of stenosis (%) before intervention and the y-axis the degree of stenosis after PTA. The number of PTAs are given below the boxes (n=). The Spearman correlation of the median residual stenosis and the primary stenosis (r = 0.93, p = 0.003) indicates a greater residual stenosis after PTA in those with a more extensive primary stenosis.
Figure 2.
Figure 2.
Months from surgery to first PTA distributed in cumulative percentage.
Figure 3.
Figure 3.
Months between the previous PTA and the next PTA given in cumulative percentage.
Figure 4.
Figure 4.
Distance (in mm) of venous stenosis from AVF anastomosis.
Figure 5.
Figure 5.
Distribution (percentage) of the various lengths of venous stenosis numbers 1–3 (in mm).
Figure 6.
Figure 6.
Distribution of cumulative survival of AVF related to the various diagnoses glomerulonephritis (GN), diabetic nephropathy (DN), interstitial nephritis (IN), hereditary diseases (Her), nephrosclerosis (NS), and other diagnoses (Other).
See this image and copyright information in PMC

References

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