Endovascular treatment of hemodialysis arteriovenous fistulas: is immediate post-interventional blood flow a predictor of patency
Endovascular treatment of hemodialysis arteriovenous fistulas: is immediate post-interventional blood flow a predictor of patency
J Vasc Access 2012; 13(3): 315 - 320
DOI:10.5301/jva.5000046
Authors
Søren T. Heerwagen, Marc A. Hansen, Torben V. Schroeder, Søren D. Ladefoged, Lars Lönn
Abstract
Purpose: The purpose of this study was to investigate if the immediate hemodynamic outcome of an endovascular intervention on a dysfunctional hemodialysis arteriovenous fistula is a prognostic factor for primary patency. Methods: This was a prospective observational study including 61 consecutive patients with dysfunctional arteriovenous fistulas referred to our endovascular unit. Patients were treated in accordance with institutional standard protocol including immediate pre- and post-interventional blood flow measurements using an intravascular catheter system. The primary endpoint was primary patency at 12 months in patients with an immediate post-interventional blood flow above or below 600 ml/min. Primary patency was estimated using the Kaplan-Meier method with the standard error of the estimate. Multivariate Cox regression analysis was used to study the effect of blood flow and other potential predictor variables. Results: Post interventional flow did not significantly influence primary patency (p = 0.76). Primary patency was found to be affected by having a history of previous intervention(s) (p = 0.008, hazard ratio 2.9) or low fistula age (P=.038, hazard ratio 0.97 [one-month increase]). Primary patency in group 1 (previous intervention(s)) was 34% ± 13% at 12 months. In group 2 (no previous intervention), primary patency at 12 months was 62% ± 9%. Conclusions: The results of this study do not provide scientific support for using the immediate hemodynamic outcome of an intervention as a prognostic factor for primary patency. Low fistula age and a history of previous intervention in particular were found to reduce primary patency significantly.
Article History
- • Accepted on 28/11/2011
- • Available online on 18/01/2012
- • Published in print on 28/09/2012
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Authors
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Heerwagen, Søren T. [PubMed] [Google Scholar]
Department of Radiology, Rigshospitalet, Copenhagen - Denmark
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Hansen, Marc A. [PubMed] [Google Scholar]
Department of Radiology, Rigshospitalet, Copenhagen - Denmark
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Schroeder, Torben V. [PubMed] [Google Scholar]
Department of Vascular Surgery, Rigshospitalet, Copenhagen and University of Copenhagen - Denmark
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Ladefoged, Søren D. [PubMed] [Google Scholar]
Department of Nephrology, Rigshospitalet, Copenhagen - Denmark
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Lönn, Lars [PubMed] [Google Scholar]
Department of Radiology, Rigshospitalet, Copenhagen - Denmark and Department of Vascular Surgery, Rigshospitalet, Copenhagen and University of Copenhagen - Denmark