Outcomes of Endovascular Intervention for Salvage of Failing Hemodialysis Access
DOI:
https://doi.org/10.35790/msj.v7i1.55971Abstract
Abstract: Chronic kidney disease (CKD) is a worldwide public health problem. Hemodialysis accesses are prone to failure due to thrombosis and stenosis over the anastomosis or outflow vein. This study aimed to obtain the outcomes of endovascular intervention for salvage of failing hemodialysis access. This was a retrospective and descriptibe study. Data were collected from all patients who underwent endovascular intervention for failing hemodialysis access starting from January 2021 – June 2023 at Prof. Dr. R. D. Kandou Hospital, Manado. The results showed that 136 subjects were included in this study. The highest comorbidities were found in patients with a history of hypertension (52.9%). The most common arteriovenous fistulas (AVF) hemodialysis access was at the brachiocephalic location (75.7%). The most frequent cause of access dysfunction was simple stenosis (64.7%). Pseudoaneurysm was occurred in two subjects (1.4%), and ruptured outflow vein was occurred in one subject (0.7%). The patency rate at three months was 77.6%, but the primary patency rate would decrease to less than 50% over six months. Endovascular intervention in the form of balloon angioplasty is currently the main line of choice in dealing with problematic AVFs in principle what is being done is to intraluminaly dilate the narrowed or blocked lumen of the outflow vein. The complication rate from the procedure performed was 2.2% where in two patients a pseudoaneurysm occurred at the puncture site, namely the brachial artery and the radial artery then another patient had rupture of the AVFs outflow vein, therefore, an additional procedure was performed to close the AVFs with ligation. In conclusion, endovascular intervention for failing hemodialysis access has good results, but the primary patency rate will decrease to less than 50% over six months.
Keywords: chronic kidney disease; hemodialysis access; endovascular intervention
References
Indonesian Renal Registry. 5th Report of Indonesian Renal Registry 2018 Indonesian Program Ren Regist. 2018 Available from: https// indonesianrenalregistry.org/data/IRR%202018.pdf
Kim KT, Ryu JW, Seo PW, Ryu KM. Clinical results of arteriovenous fistulas constructed using autologous vessels in end-stage renal disease patients on hemodialysis. Korean J Thorac Cardiovasc Surg. 2018;51(2):122–9. Doi:10.5090/kjtcs.2018.51.2.122
Takahashi EA, Harmsen WS, Misra S. Endovascular arteriovenous dialysis fistula intervention: outcomes and factors contributing to fistula failure. Kidney Med. 2020;2(3):326–31. Doi:10.1016/j.xkme.2020.02.004
Tan LTX, May KK, Robbles PA, Pei Ho. Outcomes of endovascular intervention for salvage of failing hemodialysis access. Ann Vasc Dis. 2011;4(2):87–92. Doi:10.3400/avd.oa.10.00009
de Donato G, Panzano C, Pasqui E, Alba G, Giannace G, Galzerano G, et al. Artero-venous fistulas for hemodialysis: surgical and endovascular approaches. In: Vascular Surgery. Elsevier; 2022. p. 75–84. Doi:10.1016/B978-0-12-822113-6.00003-6
Gallieni M, Hollenbeck M, Inston N, Kumwenda M, Powell S, Tordoir J, et al. Clinical practice guideline on peri- and postoperative care of arteriovenous fistulas and grafts for haemodialysis in adults. Nephrol Dial Transplant. 2019;34(Suppl 2):ii1–ii42. Doi:10.1093/ndt/gfz072
Tordoir JHM, Zonnebeld N, van Loon MM, Gallieni M, Hollenbeck M. Surgical and endovascular intervention for dialysis access maturation failure during and after arteriovenous fistula surgery: review of the evidence. Eur J Vasc Endovasc Surg. 2018;55(2):240–8. Doi:10.1016/j.ejvs.2017.12.001
Sadaghianloo N, Declemy S, Jean-Baptiste E, Haudebourg P, Robino C, Islam MS, et al. Radial artery deviation and reimplantation inhibits venous juxta-anastomotic stenosis and in- creases primary patency of radial-cephalic fistulas for hemodialysis. J Vasc Surg. 2016;64(3):698-706. Doi:10.1016/ j.jvs.2016.04.023
Almasri J, Alsawas M, Mainou M, Mustafa RA, Wang Z, Woo K, et al. Outcomes of vascular access for hemodialysis: a systematic review and meta-analysis. J Vasc Surg. 2016;64(1):236-43. Doi:10.1016/ j.jvs.2016.01.053
Zhu ZR, Zou L, Xing Y, Tan YC, Xu GJ, He ZJ, et al. Predictors of primary patency after percutaneous balloon angioplasty for stenosis of Brescia-Cimino hemodialysis arteriovenous fistula. Br J Radiol. 2020;93(1109):20190505. Doi:10.1259/bjr.20190505
Liyanage T, Toyama T, Hockham C, Ninomiya T, Perkovic V, Woodward M, et al. Prevalence of chronic kidney disease in Asia: a systematic review and analysis. BMJ Glob Health. 2022;7(1):007525. Doi:10.1136/bmjgh-2021-007525
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Billy Karundeng, Djony Tjandra, Richard Sumangkut, Michael D. Winarto
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
COPYRIGHT
Authors who publish with this journal agree to the following terms:
Authors hold their copyright and grant this journal the privilege of first publication, with the work simultaneously licensed under a Creative Commons Attribution License that permits others to impart the work with an acknowledgment of the work's origin and initial publication by this journal.
Authors can enter into separate or additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (for example, post it to an institutional repository or publish it in a book), with an acknowledgment of its underlying publication in this journal.
Authors are permitted and encouraged to post their work online (for example, in institutional repositories or on their website) as it can lead to productive exchanges, as well as earlier and greater citation of the published work (See The Effect of Open Access).
