Endovascular revascularization of chronically thrombosed arteriovenous fistulas and grafts for hemodialysis: a retrospective study in 15 patients with 18 access sites.

摘要

The current study retrospectively evaluated whether endovascular revascularization of chronically thrombosed and long-discarded vascular access sites for hemodialysis was feasible. Technical and clinical success rates, postintervention primary and secondary patency rates, and complications were reported. During a 1-year period, we reviewed a total of 924 interventions performed for dysfunction and/or failed hemodialysis vascular access sites and permanent catheters in 881 patients. In patients whose vascular access-site problems were considered untreatable or were considered treatable with a high risk of failure and access-site abandonment, we attempted to revascularize (resurrect) the chronically occluded and long-discarded (mummy) vascular access sites. We attempted to resurrect a total of 18 mummy access sites (mean age 46.6 +/- 38.7 months; range 5-144) in 15 patients (8 women and 7 men; mean age 66.2 +/- 11.5 years; age range 50-85) and had an overall technical success rate of 77.8%. Resurrection failure occurred in 3 fistulas and in 1 straight graft. The clinical success rate was 100% at 2 months after resurrection. In the 14 resurrected vascular access sites, 6 balloon-assisted maturation procedures were required in 5 fistulas; after access-site maturation, a total of 22 interventions were performed to maintain access-site patency. The mean go-through time for successful resurrection procedures was 146.6 +/- 34.3 min (range 74-193). Postmaturation primary patency rates were 71.4 +/- 12.1% at 30 days, 57.1 +/- 13.2% at 60 days, 28.6 +/- 13.4% at 90 days, and 19 +/- 11.8% at 180 days. Postmaturation secondary patency rates were 100% at 30, 60, and 90 days and 81.8 +/- 11.6% at 180 days. There were 2 major complications consisting of massive venous ruptures in 2 mummy access sites during balloon dilation; in both cases, prolonged balloon inflation failed to achieve hemostasis, but percutaneous N-butyl cyanoacrylate glue seal-off was performed successfully. Percutaneous resurrection of mummy vascular access sites for hemodialysis is technically feasible with high clinical success rates. In selected patients, resurrection of mummy access sites provides long-discarded access sites one more chance to be used for hemodialysis in an effort to preserve potential extremity sites for future access-site placement and to prevent long-term catheter indwelling.