Percutaneous management of perianastomotic stenosis in arteriovenous fistulae: Results of a prospective study

A. Asif, Oliver Lenz, D. Merrill, G. Cherla, C. D. Cipleu, R. Ellis, B. Francois, D. L. Epstein, P. Pennell

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Surgical creation of new anastomosis has been proposed as the preferred treatment for perianastomotic stenoses of fistulae. However, disadvantages of surgical approach have included (1) frequent conversion of fistula to a graft by using synthetic graft material to create a new anastomosis, (2) shortening the length of the cannulation segment by proximal autologous arteriovenous neoanastomosis, and (3) abandoning the fistula altogether in favor of a synthetic graft. We report the results of a prospective study using percutaneous balloon angioplasty (PTA) to treat fistulae with perianastomotic lesions. Seventy-three consecutive patients undergoing 112 PTA procedures for the treatment of perianastomotic lesions were studied. Primary and secondary patency rates were calculated. Procedure success, procedure-related complications, and conversion of fistulae to grafts were recorded. The initial success rate was 97%. The degree of stenosis before and after PTA was 81 ± 9 and 11 ± 11%, respectively. Primary patency rates at 6, 12, and 18 months were 75, 51, and 41%, respectively. Secondary patency rates at 6, 12, and 18 months were 94, 90, and 90%, respectively. Grade I hematoma occurred in three and vein rupture in two cases. No grafts were inserted. These outcomes are superior to those that have been reported for surgery. The outpatient PTA is safe and effective for the management of perianastomotic stenosis. Because of its advantage of fistula preservation, the percutaneous approach should be considered as the preferred first-line therapy for the management of perianastomotic fistula lesions.

Original languageEnglish
Pages (from-to)1904-1909
Number of pages6
JournalKidney International
Volume69
Issue number10
DOIs
StatePublished - May 1 2006

Fingerprint

Arteriovenous Fistula
Fistula
Pathologic Constriction
Prospective Studies
Balloon Angioplasty
Transplants
Catheterization
Hematoma
Rupture
Veins
Outpatients
Therapeutics

Keywords

  • Arterial stenosis
  • Arteriovenous fistula
  • Balloon angioplasty
  • Interventional nephrology
  • Perianastomotic stenosis

ASJC Scopus subject areas

  • Nephrology

Cite this

Percutaneous management of perianastomotic stenosis in arteriovenous fistulae : Results of a prospective study. / Asif, A.; Lenz, Oliver; Merrill, D.; Cherla, G.; Cipleu, C. D.; Ellis, R.; Francois, B.; Epstein, D. L.; Pennell, P.

In: Kidney International, Vol. 69, No. 10, 01.05.2006, p. 1904-1909.

Research output: Contribution to journalArticle

Asif, A, Lenz, O, Merrill, D, Cherla, G, Cipleu, CD, Ellis, R, Francois, B, Epstein, DL & Pennell, P 2006, 'Percutaneous management of perianastomotic stenosis in arteriovenous fistulae: Results of a prospective study', Kidney International, vol. 69, no. 10, pp. 1904-1909. https://doi.org/10.1038/sj.ki.5000358
Asif, A. ; Lenz, Oliver ; Merrill, D. ; Cherla, G. ; Cipleu, C. D. ; Ellis, R. ; Francois, B. ; Epstein, D. L. ; Pennell, P. / Percutaneous management of perianastomotic stenosis in arteriovenous fistulae : Results of a prospective study. In: Kidney International. 2006 ; Vol. 69, No. 10. pp. 1904-1909.
@article{74205aae04be4d3981412e959b61d205,
title = "Percutaneous management of perianastomotic stenosis in arteriovenous fistulae: Results of a prospective study",
abstract = "Surgical creation of new anastomosis has been proposed as the preferred treatment for perianastomotic stenoses of fistulae. However, disadvantages of surgical approach have included (1) frequent conversion of fistula to a graft by using synthetic graft material to create a new anastomosis, (2) shortening the length of the cannulation segment by proximal autologous arteriovenous neoanastomosis, and (3) abandoning the fistula altogether in favor of a synthetic graft. We report the results of a prospective study using percutaneous balloon angioplasty (PTA) to treat fistulae with perianastomotic lesions. Seventy-three consecutive patients undergoing 112 PTA procedures for the treatment of perianastomotic lesions were studied. Primary and secondary patency rates were calculated. Procedure success, procedure-related complications, and conversion of fistulae to grafts were recorded. The initial success rate was 97{\%}. The degree of stenosis before and after PTA was 81 ± 9 and 11 ± 11{\%}, respectively. Primary patency rates at 6, 12, and 18 months were 75, 51, and 41{\%}, respectively. Secondary patency rates at 6, 12, and 18 months were 94, 90, and 90{\%}, respectively. Grade I hematoma occurred in three and vein rupture in two cases. No grafts were inserted. These outcomes are superior to those that have been reported for surgery. The outpatient PTA is safe and effective for the management of perianastomotic stenosis. Because of its advantage of fistula preservation, the percutaneous approach should be considered as the preferred first-line therapy for the management of perianastomotic fistula lesions.",
keywords = "Arterial stenosis, Arteriovenous fistula, Balloon angioplasty, Interventional nephrology, Perianastomotic stenosis",
author = "A. Asif and Oliver Lenz and D. Merrill and G. Cherla and Cipleu, {C. D.} and R. Ellis and B. Francois and Epstein, {D. L.} and P. Pennell",
year = "2006",
month = "5",
day = "1",
doi = "10.1038/sj.ki.5000358",
language = "English",
volume = "69",
pages = "1904--1909",
journal = "Kidney International",
issn = "0085-2538",
publisher = "Nature Publishing Group",
number = "10",

}

TY - JOUR

T1 - Percutaneous management of perianastomotic stenosis in arteriovenous fistulae

T2 - Results of a prospective study

AU - Asif, A.

AU - Lenz, Oliver

AU - Merrill, D.

AU - Cherla, G.

AU - Cipleu, C. D.

AU - Ellis, R.

AU - Francois, B.

AU - Epstein, D. L.

AU - Pennell, P.

PY - 2006/5/1

Y1 - 2006/5/1

N2 - Surgical creation of new anastomosis has been proposed as the preferred treatment for perianastomotic stenoses of fistulae. However, disadvantages of surgical approach have included (1) frequent conversion of fistula to a graft by using synthetic graft material to create a new anastomosis, (2) shortening the length of the cannulation segment by proximal autologous arteriovenous neoanastomosis, and (3) abandoning the fistula altogether in favor of a synthetic graft. We report the results of a prospective study using percutaneous balloon angioplasty (PTA) to treat fistulae with perianastomotic lesions. Seventy-three consecutive patients undergoing 112 PTA procedures for the treatment of perianastomotic lesions were studied. Primary and secondary patency rates were calculated. Procedure success, procedure-related complications, and conversion of fistulae to grafts were recorded. The initial success rate was 97%. The degree of stenosis before and after PTA was 81 ± 9 and 11 ± 11%, respectively. Primary patency rates at 6, 12, and 18 months were 75, 51, and 41%, respectively. Secondary patency rates at 6, 12, and 18 months were 94, 90, and 90%, respectively. Grade I hematoma occurred in three and vein rupture in two cases. No grafts were inserted. These outcomes are superior to those that have been reported for surgery. The outpatient PTA is safe and effective for the management of perianastomotic stenosis. Because of its advantage of fistula preservation, the percutaneous approach should be considered as the preferred first-line therapy for the management of perianastomotic fistula lesions.

AB - Surgical creation of new anastomosis has been proposed as the preferred treatment for perianastomotic stenoses of fistulae. However, disadvantages of surgical approach have included (1) frequent conversion of fistula to a graft by using synthetic graft material to create a new anastomosis, (2) shortening the length of the cannulation segment by proximal autologous arteriovenous neoanastomosis, and (3) abandoning the fistula altogether in favor of a synthetic graft. We report the results of a prospective study using percutaneous balloon angioplasty (PTA) to treat fistulae with perianastomotic lesions. Seventy-three consecutive patients undergoing 112 PTA procedures for the treatment of perianastomotic lesions were studied. Primary and secondary patency rates were calculated. Procedure success, procedure-related complications, and conversion of fistulae to grafts were recorded. The initial success rate was 97%. The degree of stenosis before and after PTA was 81 ± 9 and 11 ± 11%, respectively. Primary patency rates at 6, 12, and 18 months were 75, 51, and 41%, respectively. Secondary patency rates at 6, 12, and 18 months were 94, 90, and 90%, respectively. Grade I hematoma occurred in three and vein rupture in two cases. No grafts were inserted. These outcomes are superior to those that have been reported for surgery. The outpatient PTA is safe and effective for the management of perianastomotic stenosis. Because of its advantage of fistula preservation, the percutaneous approach should be considered as the preferred first-line therapy for the management of perianastomotic fistula lesions.

KW - Arterial stenosis

KW - Arteriovenous fistula

KW - Balloon angioplasty

KW - Interventional nephrology

KW - Perianastomotic stenosis

UR - http://www.scopus.com/inward/record.url?scp=33646695464&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33646695464&partnerID=8YFLogxK

U2 - 10.1038/sj.ki.5000358

DO - 10.1038/sj.ki.5000358

M3 - Article

C2 - 16557220

AN - SCOPUS:33646695464

VL - 69

SP - 1904

EP - 1909

JO - Kidney International

JF - Kidney International

SN - 0085-2538

IS - 10

ER -