P325
PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY IN THE TREATMENT OF
DYSFUNCTIONAL ARTERIOVENOUS FISTULAE
Jurawan, N1, Riley, P2, Little, M3
1
Renal Institute of Birmingham, UHB NHS Trust, Edgbaston, 2Dept of Interventional
Radiology, UHB NHS Trust, Edgbaston, 3Centre for Nephrology, UCL Royal Free Campus,
London
INTRODUCTION: Percutaneous transluminal angioplasty (PTA) is often used for the treatment of
stenosis in dysfunctional arteriovenous fistulae (AVF). This study attempted to evaluate the efficacy
of this treatment modality.
METHODS: We retrospectively analysed 76 patients who underwent PTA because of AVF
dysfunction between September 2007 and June 2009. The primary combined outcome measure was
loss of AVF, angiographic recurrence of stenosis requiring re-intervention, acute AVF thrombosis or
poor dialysis adequacy requiring further angiographic investigation. The principal indications for
fistuloplasty were arm swelling (30.3%) and poor blood flow on dialysis (18.4%).
RESULTS: Fifty patients (65.8%) had 1 stenosis, 19 (25%) had 2 stenoses and 5 had 3 stenoses
(6.6%). The most common sites of stenosis were proximal vein (42 cases, 55.3%) and intra-AVF (28
cases, 36.8%) and a stent was placed in 14 cases (18.4%). A satisfactory angiographic result was
achieved in 72 cases (95%). Median duration of follow up was 91 days (range 0-516), during which
time there were 46 (60.5%) cases with a primary outcome, and 12 AVF’s were lost (15.8%, one-year
actuarial AVF survival probability = 65%). The most common outcome was re-stenosis requiring
repeat procedure (31 cases, 40.8%). Overall median time to outcome was 140 days (95% CI 90 to
190) by Kaplan-Meier analysis. The outcome was significantly improved in those with an intra-AVF
stenosis (median time to outcome 237 v 107 days, p<0.05). Although there were fewer outcomes
following stent placement (28%), this was not significantly different on life table analysis.
CONCLUSION: PTA is effective at restoring luminal patency in dysfunctional AVF’s, and is
associated with reasonable one-year AVF survival rates. However, there is a high rate of stenosis
recurrence, with further intervention required in almost 50% by 3 months. The outcome appears better
if PTA of an intra-AVF stenosis is performed.