Arteriovenous fistula geometry in hybrid recanalisation of post-thrombotic venous obstruction

2015 ◽  
Vol 30 (1_suppl) ◽  
pp. 42-49 ◽  
Author(s):  
RLM Kurstjens ◽  
R de Graaf ◽  
ME Barbati ◽  
MAF de Wolf ◽  
JHH van Laanen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Arteriovenous Fistula ◽  
Femoral Vein ◽  
Transluminal Angioplasty ◽  
Favourable Outcome ◽  
Hazard Ratio ◽  
Venous Obstruction ◽  
Arteriovenous Fistulas ◽  
Angioplasty And Stenting ◽  
Percutaneous Transluminal

Introduction Post-thrombotic obstruction can be adequately treated by percutaneous transluminal angioplasty and stenting. When post-thrombotic trabeculations extend below the femoral confluence, proper inflow can be facilitated by endophlebectomy and creation of an arteriovenous fistula. The aim of this study was to investigate whether it is more favourable to place the arteriovenous fistula at the cranial or caudal end of the endophlebectomy to prevent stenosis or occlusion. Methodology We retrospectively analysed the clinical data of all patients who underwent a hybrid procedure in our two centres. Demographics, interventional details and post-operative imaging were collected. Results Data on 42 limbs with cranially and 23 limbs with caudally placed arteriovenous fistulas were collected. Post-thrombotic disease of the profunda femoral vein alone or in combination with the femoral vein was observed more often in the cranial group. The caudal group more often received a smaller sized and straight polytetrafluoroethylene fistula, while the cranial group comprised a significantly higher amount of stented segments. Logistic regression showed that only reduced femoral inflow (hazard ratio 2.934 (95%CI, 1.148–7.494)) was a significant predictor of stent stenosis and/or occlusion. Logistic regression for risk of occlusion showed a significant influence of stent-related complications (hazard ratio 4.691 (95%CI, 1.205–18.260)) and a tendency towards influence of arteriovenous fistula geometry in favour of the cranially placed fistula. Conclusion Placement of the arteriovenous fistula in the cranial part of the endophlebectomy during hybrid recanalisation may result in a more favourable outcome, yet this tendency was not statistically significant. Moreover, femoral inflow is pivotal in maintaining patency and should thus be adequately assessed pre-operatively.

Analysis of factors for post–percutaneous transluminal angioplasty primary patency rate in hemodialysis vascular access

2020 ◽  
Vol 21 (6) ◽  
pp. 892-899
Author(s):  
Kanyu Miyamoto ◽  
Takashi Sato ◽  
Keisuke Momohara ◽  
Sumihisa Ono ◽  
Makoto Yamaguchi ◽  
...  
Keyword(s):  
Blood Flow ◽  
Confidence Interval ◽  
Arteriovenous Fistula ◽  
Percutaneous Transluminal Angioplasty ◽  
Transluminal Angioplasty ◽  
Primary Patency ◽  
Hazard Ratio ◽  
Flow Volume ◽  
Blood Flow Volume ◽  
Percutaneous Transluminal

Background: Although percutaneous transluminal angioplasty has been established as a first-line therapy for access failure in dialysis, there are few reports on primary patency after percutaneous transluminal angioplasty. We investigated factors associated with primary patency following the first percutaneous transluminal angioplasty performed after vascular access construction in patients with arteriovenous fistula, including blood flow volume before and after percutaneous transluminal angioplasty and previously reported factors. Methods: We used medical records at six dialysis centers to retrospectively identify and analyze prognostic factors for primary patency after percutaneous transluminal angioplasty in 159 patients with arteriovenous fistula who underwent initial percutaneous transluminal angioplasty after vascular access construction. Results: Multivariate analysis with the Cox proportional hazard model showed that primary patency after percutaneous transluminal angioplasty in patients with arteriovenous fistula was significantly associated with lesion length (hazard ratio, 1.76; 95% confidence interval, 1.01–3.07; P = 0.045), and blood flow volume after percutaneous transluminal angioplasty (hazard ratio, 0.71; 95% confidence interval, 0.60–0.84; P < 0.001). When blood flow volume after percutaneous transluminal angioplasty was classified into three categories, risks of outcome events defining the end of primary patency after percutaneous transluminal angioplasty were significantly lower for 400–630 mL/min (hazard ratio, 0.38; 95% confidence interval, 0.21–0.68; P = 0.001) and >630 mL/min (hazard ratio, 0.16; 95% confidence interval, 0.06–0.40; P < 0.001) compared with <400 mL/min. Conclusion: Our study showed that blood flow volume after percutaneous transluminal angioplasty is an important prognostic factor for primary patency after percutaneous transluminal angioplasty in patients with arteriovenous fistula.

scholarly journals Factors That Influence Patency of Post-Endovascular Fistula Salvage Procedure in Arteriovenous Fistula Dysfunction

2020 ◽  
Vol 1 (2) ◽  
pp. 11-15
Author(s):  
Akhmadu Muradi ◽  
Danny Pratama ◽  
Aria Kekalih ◽  
Raden Suhartono
Keyword(s):  
Arteriovenous Fistula ◽  
Average Length ◽  
Anatomic Variation ◽  
Transluminal Angioplasty ◽  
Primary Patency ◽  
Salvage Procedure ◽  
Arteriovenous Fistulas ◽  
First Choice ◽  
The Relationship ◽  
Percutaneous Transluminal

Introduction: Beyond the primacy of arteriovenous fistulas (AVF) as hemodialysis access, AVF is not always free of problems. Although the incidence of stenosis and thrombosis is low, these two obstacles can still occur. The development of endovascular fistula salvage (EFS) procedures can be a solution for non-immature AVF, stenosis, or thrombosis for functional return. There are limited factors known to support the success of EFS in patients with characteristics that exist in Indonesia. Method: People with AVF dysfunction (n = 107) performed by EFS were evaluated in a retrospective cohort between November 2015 and November 2017 to obtain a picture of post-EFS patency and was assessed for the relationship between anatomic variation, diabetes mellitus, and patient age with post-EFS AVF patency. Results: There were 133 stenoses with 66 stenoses in juxta anastomosis, 7 in feeding arteries, and 60 in draining vein fistula. The average length of the stenosis is 21.5 mm. Residual stenosis of more than 30% was found in 21 cases (15.8%). Variables that affected dysfunction were age (p = 0.038) and diabetes (p = 0.035). In this study, it was found that multiple stenoses also affected primary patency (p = 0.008). Primary patency in the first 6 months and 12 months was 82.2% and 74.8%, respectively. Complications were found in 8 cases (7.47%). Conclusion: EFS procedure on dysfunctional AVF can be the first choice compared to new AVF creation actions or heavenly revision actions. Keywords: endovascular fistula salvage, arteriovenous fistula dysfunction, percutaneous transluminal angioplasty

Indications for endophlebectomy and/or arteriovenous fistula after stenting

2013 ◽  
Vol 28 (1_suppl) ◽  
pp. 123-128 ◽  
Author(s):  
M A F De Wolf ◽  
C W K P Arnoldussen ◽  
C H A Wittens
Keyword(s):  
Arteriovenous Fistula ◽  
Clinical Success ◽  
Femoral Vein ◽  
Transluminal Angioplasty ◽  
Inguinal Ligament ◽  
Success Rates ◽  
Preoperative Prediction ◽  
Flow Through ◽  
Good Patency ◽  
Angioplasty And Stenting

Endovenous recanalization with percutaneous transluminal angioplasty and stenting in post-thrombotic syndrome patients with iliocaval obstruction is a treatment modality quickly gaining popularity. Studies show good patency and clinical success rates. If the obstruction extends distally, below the inguinal ligament, stenting remains controversial. Without adequate inflow, the patency of stented iliocaval segments drops dramatically. This suggests that treatment of diseased common femoral, femoral and profunda femoral veins is required to ensure adequate inflow. Endophlebectomy, the removal of synechiae and septae from the common femoral vein, is a viable option in these cases. Another option, which can be done concurrently with the endophlebectomy, is the creation of an arteriovenous fistula. Selecting patients for these interventions however remains difficult, as precise preoperative prediction of inflow into the stented segments is difficult. In this paper we describe our experience in using duplex ultrasonography, magnetic resonance venography and conventional venography to assess the patency of the inflow trajectory. We believe this approach is essential in dealing with cases of complex post-thrombotic disease extending below the inguinal ligament. There is a great need to establish criteria to accurately assess pre- and postinterventional flow through treated vein segments.

scholarly journals Percutaneous transluminal angioplasty and stenting for recurrent carotid artery stenosis

1998 ◽  
Vol 5 (6) ◽  
pp. E7
Author(s):  
Giuseppe Lanzino ◽  
Robert A. Mericle ◽  
Demetrius K. Lopes ◽  
Ajay K. Wakhloo ◽  
Lee R. Guterman ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Percutaneous Transluminal Angioplasty ◽  
Transluminal Angioplasty ◽  
Artery Stenosis ◽  
Cardiac Complications ◽  
Neurological Event ◽  
Angioplasty And Stenting ◽  
Percutaneous Transluminal

Percutaneous transluminal angioplasty (PTA) and stenting has recently been proposed as an alternative to surgical reexploration in patients with recurrent carotid artery stenosis following endarterectomy. The authors retrospectively reviewed their experience after performing 25 procedures in 21 patients to assess the safety and efficacy of PTA with or without stenting for carotid artery restenosis. The mean interval between endarterectomy and the endovascular procedure was 57 months (range 8-220 months). Seven arteries in five patients were treated by PTA alone (including bilateral procedures in one patient and repeated angioplasty in the same vessel in another). Early suboptimum results and recurrent stenosis in some of these initial cases prompted the authors to combine PTA with stenting in the treatment of 18 arteries over the past 3 years. No major periprocedural deficits (neurological or cardiac complications) or death occurred. There was one periprocedural transient neurological event. A pseudoaneurysm of the femoral artery (at the access site) required surgical repair. In the 16 patients who each underwent at least 6 months of follow-up review, no neurological events ipsilateral to the treated artery had occurred after a mean follow-up period of 27 months (range 6-57 months). Three of five patients who underwent PTA alone developed significant (> 50%) asymptomatic restenoses that required repeated angioplasty in one and PTA with stenting in two patients. Significant restenosis (55%) was observed in only one of the vessels treated by combined angioplasty with stenting. Endovascular PTA and stenting of recurrent carotid artery stenosis is both technically feasible and safe and has a satisfactory midterm patency. This procedure can be considered a viable alternative to surgical reexploration in patients with recurrent carotid artery stenosis.

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