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Jeong, Kim, Byun, Kang, Choi, Kim, Kim, Choi, and Park: Effect of Percutaneous Transluminal Angioplasty on the Stenosis of Autogenous Radiocephalic Arteriovenous Fistula for Hemodialysis
Interventional Radiology

Journal of the Korean Society of Radiology 2016; 74(2): 105-113.

Published online: 27 January 2016

DOI: https://doi.org/10.3348/jksr.2016.74.2.105

Effect of Percutaneous Transluminal Angioplasty on the Stenosis of Autogenous Radiocephalic Arteriovenous Fistula for Hemodialysis

Sun Min Jeong, MD1, Jeong Ho Kim, MD1, Sung Su Byun, MD1, Jin Mo Kang, MD2, Sang Tae Choi, MD2, Jong Woo Kim, MD1, Hyung Sik Kim, MD1, Hye Young Choi, MD1, Jae Hyung Park, MD3

1Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea.

2Department of Vascular Surgery, Gachon University Gil Medical Center, Incheon, Korea.

3Department of Radiology, Seonam University College of Medicine, Myongji Hospital, Goyang, Korea.

Corresponding author: Jeong Ho Kim, MD. Department of Radiology, Gachon University Gil Medical Center, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea. Tel. 82-32-460-3063, Fax. 82-32-460-3065, ho7ok7@gilhospital.com

Received 21 April 2015       Revised 31 August 2015       Accepted 15 October 2015

Copyright © 2016 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to evaluate the effectiveness of percutaneous transluminal angioplasty (PTA) on stenosis of autogenous radiocephalic arteriovenous fistula (RCF) for hemodialysis and to determine the factors influencing patency.

Materials and Methods

This retrospective study included 136 patients referred for PTA of RCF stenosis between March 2005 and July 2014. The technical success rate, complications, and patency rate were evaluated. The following factors were analyzed as they might influence patency: age, gender, site and duration of arteriovenous fistula, underlying disease, body mass index, hypercholesterolemia, smoking, peripheral artery or coronary artery occlusive disease, stenosis length/grade, cutting balloon, and balloon size.

Results

The initial technical success rate was 91.9% (125/136). Complications included vessel rupture (n = 2) and vessel dissection (n = 2). The patency rates at 6, 12, 24, and 48 months after PTA were 81.9, 67.1, 52.7, and 42.3%, respectively. The patency rate was higher in cases with longer (> 3 cm) stenosis (p = 0.04). Use of cutting balloon and larger size of balloon catheter made the patency longer, but this difference was not statistically significant (p = 0.637, 0.258).

Conclusion

PTA is a safe and effective way to manage stenosis in RCF. The length of stenosis was the only factor which affected the patency rate in this study.

Keywords: Arteriovenous Fistula, Stenosis, Percutaneous Transluminal Angioplasty, Complications, Vascular Patency

Figures and Tables

Fig. 1

Angiographic evaluation of perianastomotic stenosis.

A. Anastomotic stenosis.
B. Juxtaanastomotic stenosis.
C. Arterial stenosis.
Arrow = stenosis site, A = artery, V = vein
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Fig. 2

Percutaneous transluminal angioplasty findings of stenosis of the venous limb in RCF before (A), during (B), and after (C) ballooning.

Arrow = stenosis site, A = artery, RCF = radiocephalic arteriovenous fistula, V = vein
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Fig. 3

Primary and secondary patency rates of PTA in patients with dysfunctional RCF. Missing data: patient death or incomplete follow-up data.

PTA = percutaneous transluminal angioplasty, RCF = radiocephalic arteriovenous fistula
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Fig. 4

Patency rate of PTA in juxtaanastomotic stenosis of RCF according to balloon size. Missing data: patient death or incomplete follow-up data.

PTA = percutaneous transluminal angioplasty, RCF = radiocephalic arteriovenous fistula
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Fig. 5

Patency rate of PTA in the juxtaanastomotic stenosis of RCF with or without a cutting balloon. Missing data: patient death or incomplete follow-up data.

PTA = percutaneous transluminal angioplasty, RCF = radiocephalic arteriovenous fistula
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Table 1

Characteristics of the Patient Population (n = 136)

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Age (yr) 56 (30-79)*
Sex, n (%)
 Male 70 (52)
 Female 66 (48)
Underlying disease, n (%)
 DM + HTN 76 (56)
 HTN 28 (21)
 DM 11 (8)
 Glomerulonephritis 7 (5)
 ADPKD 3 (2)
 Congenital agenesis 1 (1)
 Obstructive nephropathy 1 (1)
 Unknown 9 (7)
Stenosis site, n (%)
 Perianastomosis stenosis 105 (77)
  Juxtaanastomotic stenosis 75
  Anastomotic stenosis 0
  Arterial stenosis 3
  Combined stenosis† 27
 Distal stenosis 15 (11)
 Central stenosis 0 (0)
 Perianastomosis + distal or central stenosis 15 (11)
 Distal + central stenosis 1 (1)

*Age range in the parenthesis.

†Combined stenosis are the cases that there are more than two stenosis in the juxtaanastomotic and aterial site, juxtaanastomotic and anastomotic site, or arterial and anastomotic site.

ADPKD = autosomal dominant polycystic kidney disease, DM = diabetes mellitus, HTN = hypertension

Table 2

Primary Patency Rate According to Factors in Patient with RCF

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Risk Factor Patency (%) p-Value
6 Month 12 Month 24 Month 48 Month
Sex 0.23
 Female (n = 63) 78.1 63.9 50.0 32.0
 Male (n = 62) 85.3 69.2 53.6 49.8
Age 0.764
 < 60 yrs (n = 72) 78.4 65.8 48.6 43.7
 ≥ 60 yrs (n = 53) 86.6 67.0 57.2 30.0
Site of RCF 0.776
 Left (n = 98) 81.0 66.7 49.8 44.8
 Right (n = 27) 83.2 68.5 63.2 33.7
Underlying disease 0.705
 DM (n = 11) 75.0 60.0 30.0
 DM + HTN (n = 69) 85.9 68.6 52.6 46.0
 HTN (n = 25) 77.6 72.5 55.2 46.0
 Other (n = 20) 74.2 54.0 54.0 30.0
Duration of use* 0.551
 ≤ 12 mo (n = 76) 78.0 67.8 48.9 44.4
 > 12 mo (n = 26) 85.0 68.3 53.1 25.3
BMI (kg/m2)† 0.788
 Normal (< 25, n = 95) 82.1 64.7 50.1 43.0
 Overweight (25–29.9, n = 25) 81.0 76.2 58.9 33.7
 Obesity (≥ 30, n = 4) 75.0 37.5 37.5 37.5
Hypercholesterolemia 0.924
 Yes (n = 30) 81.9 61.5 48.8 39.1
 No (n = 95) 81.4 68.2 52.8 43.1
Smoking 0.363
 Yes (n = 14) 88.9 88.9 61.0 61.0
 No (n = 111) 80.8 64.3 50.8 40.3
PAOD 0.878
 Yes (n = 10) 77.8 66.7 44.4 44.4
 No (n = 115) 82.0 66.5 52.7 41.0
CAOD 0.206
 Yes (n = 29) 76.9 69.0 64.7 57.5
 No (n = 96) 83.2 65.5 46.6 36.8
Site of stenosis 0.192
 Perianastomsis (n = 96) 82.3 69.9 54.7 44.3
 Perianastomosis + distal/central (n = 15) 84.5 53.8 53.8 40.4
 Distal/central (n = 14) 71.8 57.4 57.4
Grade of stenosis 0.992
 50–69% (n = 55) 78.5 68.0 49.1 43.0
 70–100% (n = 70) 83.6 65.4 53.3 41.0
Length of stenosis 0.04
 < 3 cm (n = 57) 71.8 56.8 39.5 31.6
 ≥ 3 cm (n = 68) 89.4 74.2 60.3 48.8

*There are 23 cases of data loss about duration of use.

†There are one case of data loss about BMI.

BMI = body mass index, CAOD = coronary artery occlusive disease, DM = diabetes mellitus, HTN = hypertension, PAOD = peripheral arterial occlusive disease, RCF = radiocephalic arteriovenous fistula

Table 3

Primary Patency Rate According to Cutting Balloon and Balloon Size in Patient with Juxtaanastomosis Stenosis of Radiocephalic Arteriovenous Fistula

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Factor Patency (%) p-Value
6 month 12 month 24 month 48 month
Cutting balloon 0.637
 Yes (n = 16) 92.9 71.4 56.3 56.3
 No (n = 89) 81.9 68.5 54.8 45.2
Balloon size 0.258
 4–5 mm (n = 30) 72.2 63.9 53.7 53.7
 6 mm (n = 51) 85.5 64.8 48.5 44.5
 7–8 mm (n = 24) 95.0 85.0 73.7 53.6

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