Endovascular treatment of hemodialysis arteriovenous fistulas: is immediate post-interventional blood flow a predictor of patency

TY - JOUR

T1 - Endovascular treatment of hemodialysis arteriovenous fistulas

T2 - is immediate post-interventional blood flow a predictor of patency

AU - Heerwagen, Søren T

AU - Hansen, Marc A

AU - Schroeder, Torben V

AU - Ladefoged, Søren D

AU - Lönn, Lars

PY - 2012/7

Y1 - 2012/7

N2 - Purpose: The purpose of this study was to investigate if the immediate hemodynamic outcome of an endovascular intervention on a dysfunctional hemodialysis arteriovenous fistula is a prognostic factor for primary patency. Methods: This was a prospective observational study including 61 consecutive patients with dysfunctional arteriovenous fistulas referred to our endovascular unit. Patients were treated in accordance with institutional standard protocol including immediate pre- and post-interventional blood flow measurements using an intravascular catheter system. The primary endpoint was primary patency at 12 months in patients with an immediate post-interventional blood flow above or below 600 ml/min. Primary patency was estimated using the Kaplan-Meier method with the standard error of the estimate. Multivariate Cox regression analysis was used to study the effect of blood flow and other potential predictor variables. Results: Post interventional flow did not significantly influence primary patency (p = 0.76). Primary patency was found to be affected by having a history of previous intervention(s) (p = 0.008, hazard ratio 2.9) or low fistula age (P=.038, hazard ratio 0.97 [one-month increase]). Primary patency in group 1 (previous intervention(s)) was 34% ± 13% at 12 months. In group 2 (no previous intervention), primary patency at 12 months was 62% ± 9%. Conclusions: The results of this study do not provide scientific support for using the immediate hemodynamic outcome of an intervention as a prognostic factor for primary patency. Low fistula age and a history of previous intervention in particular were found to reduce primary patency significantly.

AB - Purpose: The purpose of this study was to investigate if the immediate hemodynamic outcome of an endovascular intervention on a dysfunctional hemodialysis arteriovenous fistula is a prognostic factor for primary patency. Methods: This was a prospective observational study including 61 consecutive patients with dysfunctional arteriovenous fistulas referred to our endovascular unit. Patients were treated in accordance with institutional standard protocol including immediate pre- and post-interventional blood flow measurements using an intravascular catheter system. The primary endpoint was primary patency at 12 months in patients with an immediate post-interventional blood flow above or below 600 ml/min. Primary patency was estimated using the Kaplan-Meier method with the standard error of the estimate. Multivariate Cox regression analysis was used to study the effect of blood flow and other potential predictor variables. Results: Post interventional flow did not significantly influence primary patency (p = 0.76). Primary patency was found to be affected by having a history of previous intervention(s) (p = 0.008, hazard ratio 2.9) or low fistula age (P=.038, hazard ratio 0.97 [one-month increase]). Primary patency in group 1 (previous intervention(s)) was 34% ± 13% at 12 months. In group 2 (no previous intervention), primary patency at 12 months was 62% ± 9%. Conclusions: The results of this study do not provide scientific support for using the immediate hemodynamic outcome of an intervention as a prognostic factor for primary patency. Low fistula age and a history of previous intervention in particular were found to reduce primary patency significantly.

U2 - 10.5301/jva.5000046

DO - 10.5301/jva.5000046

M3 - Journal article

C2 - 22266582

SN - 1129-7298

VL - 13

SP - 315

EP - 320

JO - Journal of Vascular Access

JF - Journal of Vascular Access

IS - 3

ER -