Volume 24, Issue 105, September - October, 2020

Criteria for Successful Salvage of Failing Autogenous Hemodialysis Arteriovenous Fistulae Using balloon Angioplasty

Ahmed Fathy Abdelaziz Abohadr^♦, Mohamed Mahmoud Zaki, Atef Abdel Hameed Desoky, Mostafa Soliman Abdelbary

Department of vascular surgery, Ain Shams University, Cairo, Egypt

^♦Corresponding author
Ahmed Fathy, Department of vascular surgery, Ain Shams University, Tel: +201009790543; E-mail: ahmed.f.abohadr@gmail.com

ABSTRACT

Background: Hemodialysis arteriovenous fistula dysfunction is a big challenging problem. Maintenance of this vascular access is one of corner stones in the care of patients with end stage renal disease. Ballooning angioplasty is the first line of salvage of failing arteriovenous fistula (AVF) due to stenosis of venous outflow. Aim: This prospective study aims at exploring factors affecting the outcome of ballooning angioplasty of failing arteriovenous fistula and postulating criteria for success of intervention. Methods: 40 patients with failing autogenous arteriovenous fistulae were recruited for percutaneous transluminal balloon angioplasty in the period from May 2018 to May 2019, follow up done for one year till May 2020. Technical & Clinical success rates were reported. The variables, including patients’ demographics, co-morbidities, medications, fistula age, fistula type, site, number of lesions and degree of stenosis were analyzed and correlated with primary and secondary patency rates. Results: The median age of the AVF in this study since their creation was 24 months, we had 40 failing AVF: 16 (40%) radiocephalic AVF, 17 (42.5%) brachiocephalic AVF and 7 (17.5%) brachiobasilic AVF. The most common cause of autogenous AVF dysfunction was 90-99% stenosis while the most common site of stenosis was juxta-anastomotic (52.5%). Technical and clinical success rates of the study population were 97.5% and 95% respectively. The median postintervention primary and secondary patency during one year follow up were 6 and 12 months respectively. The primary patency at 1, 3, 6, 9, 12 months were 87.5%, 75%, 55%, 40% and 32.5% respectively. Univariate cox regression analysis of the variables that potentially affect success and patency of the procedure we found that three factors are associated with decrease both primary and secondary patency. Hyperlipidemia was associated with decrease primary patency with HR (95% CI) of 2.475 (1.034 – 5.926) and p-value of 0.042 and decrease in secondary patency with HR (95% CI) of 15.848 (1.839 – 136.586) and p-value of 0.012. Insulin intake was associated with decrease in primary patency with HR (95% CI) 3.531 (1.526 – 8.168) and p-value of 0.003 and decrease in secondary patency with HR (95% CI) 13.452 (1.563– 115.748) and p-value of 0.018. The presence of cephalic arch stenosis was also associated with decrease in primary patency with HR (95% CI) 4.950 (1.983 – 12.355) and p-value of 0.001 and decrease in secondary patency with HR (95% CI) 29.856 (3.418 – 260.795) and with p-value = 0.002. Multivariate cox regression analysis was done for the variables with significant association in univariate analysis (table 3) and found that primary patency was reduced by insulin intake with HR (95% CI) of 2.876 (1.200 – 6.889) and p-value of 0.018 and the presence of cephalic arch stenosis HR (95% CI) of 3.050 (1.158 – 8.030) and p value 0.024. And the secondary patency was found to be reduced only by the presence of cephalic arch stenosis HR (95% CI) of 17.794 (1.463 – 220.814) and p value 0.024. Conclusion: Ballooning angioplasty is an important method for salvage of failing hemodialysis arteriovenous fistula but the primary and secondary patency affected hugely by the site of stenosis (cephalic arch stenosis is associated with least primary and secondary patency); the use of some drugs as insulin decrease the primary patency. There is no proved association between medical comorbidities and patency.

Keywords: Hemodialysis autogenous arteriovenous fistula, failing arteriovenous fistula, vascular access salvage, cephalic arch stenosis, end stage renal disease

Medical Science, 2020, 24(105), 3312-3318

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