Short-term results of percutaneous transluminal balloon angioplasty for a failing brachial arteriovenous fistula

Purpose
The purpose of this paper is to review short-term results of percutaneous transluminal angioplasty (PTA) in treating a failing brachial arteriovenous access (AVF) in terms of safety, durability, and efficacy.
Patients and methods
This study was performed on 20 patients (12 men and 8 women). Full history taking, examination, and risk factors identification were performed. Fistulogram was done using a radial sheath to detect site and number of the stenotic segments, and accordingly appropriate balloon size was selected for treating the diseased segment(s). Outcome of the procedure was assessed by success rate (clinically, technically, and angiographyically) and so primary patency rate was measured. Also, all complications were registered during follow-up period of 6 months.
Results
Success rate (1ry patency) of AVF during the follow-up period was 90% in the first 2 days then decreased to 65% 6 months after the procedure, due to restenosis or occlusion. Regarding complications, one patient (5%) had an infected AVF that was ligated as it was beyond salvage, two patients (10%) had puncture site hematoma that was treated conservatively with good outcome, rupture AVF in one patient (5%) that was treated by AVF ligation (rupture at body of the AVF), and immediate thrombosis and inability to cross the site of tight stenosis or near total occlusion in one patients (5%) that led to immediate failure of the procedure (PTA). It was also observed that the success rate (1ry patency) tends to decrease in patients older than 60 years and in diabetic patients. This correlation was statistically significant ( value=0.017).
Conclusion
Patency of AVF can be maintained with continuous monitoring and follow-up. PTA for a failing AVF is an effective and safe mode of treatment with no need for temporary hemodialysis catheters insertion or creation of surgical wounds with its morbidities.