Purpose: To retrospectively review the incidence and types of arterial problems associated with dysfunctional hemodialysis grafts in patients who are at high risk for peripheral arterial disease.
Materials and methods: During the 1-year period from February 2001 to February 2002, 40 patients with polytetrafluoroethylene hemodialysis grafts underwent upper extremity arteriography to evaluate arterial inflow to the vascular access. The indication for arteriography was based on the presence of at least two of the following risk factors for peripheral vascular disease: diabetes mellitus, hypertension, and age greater than 65 years. Thirty-three of the 40 patients were women and the median age was 65 years. Thirty-three patients had forearm loop-configuration grafts and seven had upper-arm grafts.
Results: Upper extremity arteriography revealed 13 arterial inflow lesions in 11 of the 40 patients (28%). Ten patients had stenoses at the arterial anastomosis. Two of these patients also had stenoses in the brachial artery. One patient had a single stenosis in the brachial artery. Eight of the 11 patients (73%) underwent angioplasty of seven arterial anastomotic stenoses and three brachial artery stenoses. Comparative analysis revealed that the presence of risk factors for atherosclerotic disease did not correlate with an increased incidence of arterial inflow problems. Surprisingly, patients with diabetes mellitus had a decreased likelihood (P =.03) of having an arterial abnormality.
Conclusion: Although the incidence of arterial anastomotic stenoses in our study group was higher than previously reported, patients undergoing hemodialysis who have risk factors for peripheral vascular disease do not have a high prevalence of native arterial lesions.