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ORIGINAL ARTICLE
Year : 2019  |  Volume : 3  |  Issue : 3  |  Page : 583-586

Role of percutaneous transluminal angioplasty for radiocephalic fistulae with junctional stenosis


Vascular Surgery, Al Azhar University, Egypt

Correspondence Address:
MD, AFMG Sameh E Elimam
134, 2nd District, 4th Area, 5th Settlement, New Cairo, 11835
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjamf.sjamf_40_19

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Background Morbidity from end-stage renal disease is primarily from vascular access. Access thrombosis is the main cause of arterio venous (AV) access failure. Decreased fistula blood flow leads to access thrombosis in arteriovenous fistulae, which occurs secondary to venous stenosis. Junctional stenosis is a complication of arteriovenous fistulas. Surgical correction and percutaneous transluminal angioplasty may correct it. Our study aimed to clarify factors for primary success of percutaneous transluminal angioplasty of radiocephalic fistulae with stenosis at the arteriovenous junction with long-term patency on follow-up. Radiocephalic junctional stenosis of fistulae involves both the radial artery and cephalic vein and site of bifurcation. Usually, radiocephalic fistula stenosis is located in the venous limb near the arteriovenous junction. Patients and methods This prospective study included 50 percutaneous transluminal angioplasty cases with stenosis at the arteriovenous junction of radiocephalic fistulae. Demographic data including age, sex, site of fistula (right or left arm), and approach (radial artery or cephalic vein) were recorded. Analysis included primary percutaneous transluminal angioplasty success and long-term patency rates. Results The total primary success rate was 88%. The existence of total occlusion was recognized as the only factor significantly associated with a high procedural failure rate (83.3 vs. 16.6%, P=0.03). For long-term patency rate, the only significant factor was the involvement of proximal radial artery dilatation (P=0.023). The 6, 12, and 18-month patency rates were 66.4, 46.8, and 23.1%, respectively, for all procedures. Conclusion Percutaneous transluminal angioplasty for junctional stenosis at radiocephalic fistula involving both the radial artery and cephalic vein at the site of anastomosis without dilating the radial artery side of the arteriovenous junction reduces the long-term patency rate; however, the initial success rate will not be affected. Initial procedural failure depends on presence of occlusive lesion mainly.


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