Percutaneous Intervention for Permanent Hemodialysis Access.
10.3348/jkrs.2003.48.1.29
- Author:
Jae Hyung KIM
1
;
Young Soo DO
;
Sung Wook SHIN
;
Sung Wook CHOO
;
Wei Chiang LIU
;
Woo Seong HUH
;
Ha Young OH
;
Dong Ik KIM
;
In Wook CHOO
;
Hong Sik BUYN
Author Information
1. Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea. ysdo@smc.samsung.co.kr
- Publication Type:Original Article
- Keywords:
Fistula, arteriovenous;
Graft arteriovenous fistula;
Transluminal angioplasty;
Thrombolysis
- MeSH:
Angioplasty;
Arteriovenous Fistula;
Constriction, Pathologic;
Humans;
Renal Dialysis*;
Transplants;
Urokinase-Type Plasminogen Activator;
Veins
- From:Journal of the Korean Radiological Society
2003;48(1):29-37
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: To evaluate the effectiveness of percutaneous transluminal angioplasty (PTA) and pulse-spray pharmacomechanical thrombolysis (PSPMT) using urokinase for the management of insufficient hemodyalitic access, and to identify contributory patency-related factors following interventional procedures. MATERIALS AND METHODS: Between August 1995 and July 2001, 105 cases of insufficient hemodyalitic access involving 38 artificial arteriovenous fistulae (AVF) and 67 graft arteriovenous fistulae (AVG) were treated interventionally. The patients underwent PTA alone in 53 cases and PSPMT combined with PTA in 47, and procedural success and long-term patency were evaluated in terms of a patient's age and sex, the presence of diabetes, the location of access, the type of AVG, the draining vein of AVG, the presence of central vein stenosis, the degree of residual stenosis, and the method of interventional procedure, and contributory factors were thus identified. RESULTS: The overall technical success rate of interventional management was 83.8% (88/105), while the overall primary patency rate was 58.7+/-5.2% at 6 months, 43.0+/-6.0% at 1 year, and 18.1+/-6.0% at 2 years. In AVF/AVG groups, primary patency rates were 55.9+/-9.2%/57.8+/-6.5% at 6 months, 45.8+/-10.0%/42.7+/-8.4% at 1 year, and 21.8%+/-9.8%/18.9+/-6.5% at 2 years. The overall secondary patency rate was 40.0+/-8.1% at 2 years. No contributory factors were found (95% confidence level), though patency of access decreased when residual stenosis was more than 30% (p=0.054). CONCLUSION: Interventional management of insufficient hemodyalitic access has high success and patency rates, and is an effective primary method. There appear to be no contributory factors, though residual stenosis of more than 30% tends to decrease the patency of hemodialytic access.
