Patency of Stenotic Arteriovenous Fistula (AVF) after Percutaneous Balloon Angioplasty (PTA)
Chumpol Wongwanit MD*, Thattiya Simasinha MD*, Pramook Mutirangura MD*, Chanean Raungsetakit MD*, Khamin Chinsakchai MD*, Nuttawut Sermsathanasawadi MD, PhD*, Suteekanit Hahtapornsawan MD*, Kiattisak Hongku MD*
Affiliation : * Division of Vascular Surgery, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Despite its high long-term patency rate and low incidence of infection and thrombosis, native AVF is frequently
interfered by stenosis. This troubleshooting can be managed by PTA for prolonging survival function of AVF and enhancing
primary-assisted patency of AVF stenoses.
Objective : To evaluate the primary-assisted patency of AVF stenoses after treated by PTA.
Material and Method: A retrospective study enrolled all hemodialysis patients who had undergone PTA for arm AVF
stenoses at Siriraj Vascular Unit from 1 January 2008 to 31 May 2012. The follow-up period was 12 months. Primary-
assisted patency was taken into account during an interval from the time of PTA until any intervention to maintain the access
patency or access abandonment. Kaplan-Meier test was applied for analyzing primary-assisted patency of the treated AVF
stenoses.
Results : Of all 76 patients with symptomatic or troubleshooting AVF stenoses underwent PTA, forty-one patients (53.9%)
were male. Mean age of the patients was 60.4 years. Thirty-seven patients (48.7%) were on hemodialysis via brachio-
cephalic AVF. Regarding underlying diseases, 92.1% were hypertension, 47.4% diabetes mellitus, 40.8% dyslipidemia, and
18.4% coronary arterial disease. Technical success rate was 83%. The primary-assisted patency rates of the treated AVF
stenoses at 3, 6, and 12 months were 86.75%, 77.34%, and 68.74%, respectively. Minor complications occurred in 6 patients
(7.9%). Postoperative hematoma was presented in 3 patients (3.9%) whereas 3 developed extravasation. All minor complications
required no surgical correction. According to Kaplan-Meier test, the mean survival function of the treated AVFs was 53.4
months. Chi-square allowed for a subgroup analysis in those underwent pre-emptive PTA.
Conclusion : Since PTA is an effective and a safe procedure to treat autologous arteriovenous fistula stenosis with a 1-year
primary-assisted patency rate at 68.74% and minor complication rate (requires no surgical correction) at 7.9%, it should be
adopted as a first-line management of the trouble shooting AVF stenosis.
Keywords : Percutaneous balloon angioplasty, Arteriovenous fistula stenosis, Hemodialysis access
