Abstract: TH-PO769

Outcome of Endovascular Salvage of Immature Hemodialysis (HD) Arteriovenous Fistulae (AVF)

Session Information

Category: Dialysis

  • 603 Hemodialysis: Vascular Access

Authors

  • Yoon, Hye Eun, The Catholic University of Korea College of Medicine, Seoul, Korea (the Republic of)
  • Kim, Yaeni, The Catholic University of Korea College of Medicine, Seoul, Korea (the Republic of)
  • Chung, Byung ha, The Catholic University of Korea College of Medicine, Seoul, Korea (the Republic of)
  • Choi, Bumsoon, The Catholic University of Korea College of Medicine, Seoul, Korea (the Republic of)
  • Park, Cheol Whee, The Catholic University of Korea College of Medicine, Seoul, Korea (the Republic of)
  • Yang, Chul Woo, The Catholic University of Korea College of Medicine, Seoul, Korea (the Republic of)
  • Kim, Yong-Soo, The Catholic University of Korea College of Medicine, Seoul, Korea (the Republic of)
Background

To assess the anatomical causes of immature AVF and the outcome of endovascular salvage.

Methods

Anatomical causes, clinical characteristics, and the success rate of endovascular salvage of 110 immature AVF were analyzed.

Results

A total of 110 patients included 52 females and 64 diabetics. The mean age was 63±13 years old. The access types were radiocephalic (n=62), brachiocephalic (n=45), and transposed brachiobasilic (n=3) fistulae. At the time of angiography, 75 patients were maintained on HD using catheters. Mean interval between AVF creation and referral to angiography was 94±69 days.
Angiography revealed stenoses (n=49; 26 inflow, 9 outflow, and 14 mixed), accessory veins (n=16), and inadequate selection of vessels (n=2) in 62 patients with radiocephalic fistulae. It revealed stenoses (n=41; 14 inflow, 17 outflow, and 10 mixed), accessory veins (n=11), deeply located cephalic veins (n=2), and inadequate selection of vessels (n=4) in 48 patients with upper arm fistulae.
Endovascular procedures performed in 107 patients included percutaneous transluminal angioplasty (PTA) (n=95) and accessory vein obliteration (n=27; 1 percutaneous, 12 surgical ligations, 14 coil insertions). The number of procedures was once in 83, twice in 17, and three times in 7 patients. The overall technical and clinical success rates were 95.2% and 92.3%. Mean interval between endovascular procedure and the first successful cannulation of the fistula was 26±17 days in patients on maintenance HD
At 3, 6, 12, and 24 months following the first successful cannulation, the primary patency rates were 84.7%, 71.0%, 57.4%, and 39.7%, respectively. Assisted patency rates of 97.7%, 95.2%, 91.0%, and 79.0% and secondary patency rates of 98.9%, 97.5%, 96.1% and 91.4% at 3, 6, 12, and 24 months, respectively.
Multivatiate Cox regression analyses revealed mixed stenosis to be the only determinant that affects secondary patency rate of immature AVF. Consistently, immature AVF with mixed stenosis showed poorer access outcome in terms of secondary patency rate compared with that of no mixed stenosis. (p < 0.001)

Conclusion

Immature AVF can be salvaged by aggressive and timely intervention. Endovascular procedures can salvage the majority of cases with high success and patency rates. The presence of mixed stenosis is associated with poor access outcome.