Endovascular Treatment of Juxta-Anastomotic Venous Stenoses of Forearm Radiocephalic Fistulas: Long-Term Results and Prognostic Factors

J Vasc Interv Radiol. 2013 Apr;24(4):558-64; quiz 565. doi: 10.1016/j.jvir.2012.12.004. Epub 2013 Feb 4.

Abstract

Purpose: To evaluate long-term results of endovascular procedures in treatment of venous juxta-anastomotic stenoses (JASs) of native forearm radiocephalic arteriovenous fistulas (AVFs) and to identify prognostic factors influencing these results.

Materials and methods: During a 124-month period, 147 endovascular interventions were performed in 75 forearm radiocephalic AVFs with JASs defined as stenoses located within the first 5 cm of the outflow vein. Prognostic factors included patient characteristics (age, sex, diabetes), AVF-related characteristics (location on forearm, age, maturity), stenosis-related characteristics (position relative to anastomosis, length, and degree), and degree of residual stenosis and delay of restenosis after the first endovascular procedure.

Results: At 1 and 3 years, access primary patency (PP) rates were 46.6% (95% confidence interval [CI], 36.3%-59.9%) and 25.5% (95% CI, 15.7%-41.6%) and assisted PP (APP) rates were 81.3% (95% CI, 72.6%-91.1%) and 63.2% (95% CI, 50.6%-79.0%), respectively. Stenosis degree of 50%-75% (P = .017), stenosis length of 10 mm or more (P = .017), and time before first restenosis of less than 6 months (P = .03) significantly increased the frequency of endovascular procedures during follow-up. However, only the degree of residual stenosis after the first endovascular treatment significantly affected long-term APP (P = .039). When residual stenosis was less than 50%, 1- and 2-year access APP rates were 84.6% (95% CI, 75.8%-94.4%) and 76.1% (95% CI, 64.6%-89.6%), respectively. When it was at least 50%, the respective APP rates were 62.3% (95% CI, 38.9%-99.9%) and 46.8% (95% CI, 22.4%-97.7%).

Conclusions: Endovascular treatment of JASs in forearm radiocephalic AVFs provides good long-term results except when the residual stenosis after the first procedure is 50% or more. In that case, the optimal treatment remains to be determined.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Angioplasty, Balloon* / adverse effects
  • Angioplasty, Balloon* / instrumentation
  • Arteriovenous Shunt, Surgical / adverse effects*
  • Child
  • Constriction, Pathologic
  • Female
  • Forearm / blood supply*
  • Graft Occlusion, Vascular / diagnosis
  • Graft Occlusion, Vascular / etiology
  • Graft Occlusion, Vascular / physiopathology
  • Graft Occlusion, Vascular / therapy*
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Radial Artery / physiopathology
  • Radial Artery / surgery*
  • Renal Dialysis
  • Retrospective Studies
  • Risk Factors
  • Stents
  • Time Factors
  • Treatment Outcome
  • Vascular Patency
  • Young Adult