%0 Journal Article
%T Is Repeat PTA of a Failing Hemodialysis Fistula Durable?
%A Ioannis Bountouris
%A Thorarinn Kristmundsson
%A Nuno Dias
%A Zbigniew Zdanowski
%A Martin Malina
%J International Journal of Vascular Medicine
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/369687
%X Purpose. Our objective was to evaluate the outcome of percutaneous transluminal angioplasty (PTA) and particularly rePTA in a failing arteriovenous fistula (AV-fistula). Are multiple redilations worthwhile? Patients and Methods. All 159 stenoses of AV fistulas that were treated with PTA, with or without stenting, during 2008 and 2009, were included. Occluded fistulas that were dilated after successful thrombolysis were also included. Median age was 68 (interquartile range 61.5¨C78.5) years and 75% were male. Results. Seventy-nine (50%) of the primary PTAs required no further reintervention. The primary patency was 61% at 6 months and 42% at 12 months. Eighty (50%) of the stenoses needed at least one reintervention. Primary assisted patency (defined as patency after subsequent reinterventions) was 89% at 6 months and 85% at 12 months. The durability of repeated PTAs was similar to the durability of the primary PTA. However, an early primary PTA carried a higher risk for subsequent reinterventions. Successful dialysis was achieved after 98% of treatments. Nine percent of the stenoses eventually required surgical revision and 13% of the fistulas failed permanently. Conclusion. The present study suggests that most failing AV-fistulas can be salvaged endovascularly. Repeated PTA seems similarly durable as the primary PTA. 1. Introduction The number of dialysis patients with end-stage renal failure increases by more than 4% per year in Sweden, with a current prevalence of 900 dialysis patients per million inhabitants [1]. These patients are always concerned about the function of their vascular access because their quality of life depends on it. Fistulas often stenose and may become dysfunctional. Stenoses necessitate reinterventions or creation of a Ħ°de novoĦħ fistula. The number of possible access sites is limited. PTA has become the treatment of choice for stenoses in AV fistulas, as it is less invasive than open surgery. The reduced need for surgical reinterventions and new fistulas seems to be a direct consequence of this strategy (Figure 1). Figure 1: Number of PTAs and surgical operations in hemodialysis fistulas per year at our institution. The aim of the present study is to assess the durability of PTA in AV fistulas in a center that predominantly uses this technique for salvage of failing fistulas and particularly to evaluate the efficacy of multiple rePTAs: is it worthwhile to dilate a fistula multiple times? 2. Patients and Methods Data from all 106 patients treated with a primary PTA of an AV fistula between January 2008 and December 2009 were
%U http://www.hindawi.com/journals/ijvm/2014/369687/