Endovascular treatment of immature, dysfunctional and thrombosed forearm autogenous ulnar-basilic and radial-basilic fistulas for haemodialysis
| Autor: | Georges Brillet, Ana Natário, Luc Turmel-Rodrigues, Anne Girault-Lataste, Mahammed Fodil-Cherif, Albert Mouton, Geneviève Dumont |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
Adult
Male medicine.medical_specialty Fistula medicine.medical_treatment Catheterization Ulnar Artery Young Adult Arteriovenous Shunt Surgical Forearm Renal Dialysis Humans Medicine Aged Retrospective Studies Thrombectomy Aged 80 and over Transplantation medicine.diagnostic_test business.industry Thrombosis Interventional radiology Retrospective cohort study Middle Aged medicine.disease Surgery Stenosis medicine.anatomical_structure Nephrology Female Radiology Hemodialysis business Kidney disease |
| Zdroj: | Nephrology Dialysis Transplantation. 25:532-538 |
| ISSN: | 1460-2385 0931-0509 |
| DOI: | 10.1093/ndt/gfp467 |
| Popis: | Background. Forearm basilic fistulas are rarely used as vascular accesses for haemodialysis but they represent a valuable option when autogenous radial-cephalic fistulas cannot be performed. There is no information in the literature to date about the outcome of direct ulnar-basilic or transposed radial-basilic forearm autogenous fistulas after endovascular treatment of stenosis or thrombosis. Methods. This retrospective study included 78 consecutive patients from eight dialysis units who were referred to a single interventional radiology centre for endovascular treatment of delayed maturation (n = 30), dysfunction (n = 35) or thrombosis (n = 13) of their autogenous forearm ulnar-basilic (n = 62) or radial-basilic fistulas (n = 16). The male/female ratio was 54/24, mean age was 64.7 years, 26% had diabetes, 83% were treated for hypertension and the mean body mass index was 24 kg/m 2 . Immature and dysfunctional fistulas were treated by dilation and thrombosed fistulas by aspiration thrombectomy. Clinical success was defined as the perception of a continuous palpable thrill and the ability to perform dialysis. Fistula patency rates were calculated with the Kaplan―Meier method. Results. Overall primary patency rates were 51 % and 44% at 1 and 2 years, respectively. These rates were lower for immature and thrombosed fistulas compared to dysfunctional mature fistulas. Secondary patency rates were 96% and 91 % at 1 and 4 years, respectively. Immediate overall clinical success was 97%. The two failures occurred with an immature and a thrombosed fistula. Immediate complications included two transient dilation-induced ruptures treated by prolonged balloon inflation. One case of subsequent hand ischaemia was successfully treated by distal artery ligation. Conclusions. Endovascular treatment plays a major role in the maturation process, maintenance and salvage of radial and ulnar-basilic fistulas. The preservation of upper arm veins for the future, with low risk of hand ischaemia or hyperflow, might encourage nephrologists and surgeons to consider forearm basilic fistulas systematically in their strategy of vascular access creation. |
| Databáze: | OpenAIRE |
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