New study evaluates factors predicting restenosis in arteriovenous fistulas undergoing intervention

Maintaining long-term hemodialysis access continues to be a challenge in patients with end stage renal disease. Stenosis of native AVFs secondary to neointimal hyperplasia is the most common cause of poorly functioning AVFs and angioplasty is the preferred treatment. This retrospective study aimed to determine predictors of primary and secondary patency after balloon angioplasty of native AVFs. Patient demographics, vasoactive medications, AVF/lesion characteristics, and biochemical data from 207 patients undergoing their first angioplasty of a native AVF were analyzed to determine predictors of AVF patency. An average of 2.2 interventions was performed per patient. Upper arm AVFs, AVFs less than 6 months old, multiple stenoses, and degree of pre procedural stenosis were significantly associated with a shorter time to fistula restenosis or thrombosis. A history of a previously abandoned fistula was the only identified risk factor for post intervention secondary patency loss. Systemic factors such as patient comorbidities, metabolic and inflammatory markers, and vasoactive medication usage did not affect primary patency.

Comments:

This is one of the largest studies to date looking at factors predicting shorter interval restenosis of AVFs postangioplasty. Multiple stenoses was identified as a risk factor for the first time. Unlike prior, smaller studies, pre procedural degree of stenosis was associated with an increased risk of post intervention primary latency loss (HR 1.3 per 10% increase). With these findings, one may consider incorporating more intensive monitoring of fistula function into their treatment algorithm when encountering a lesion with a high degree of stenosis.


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Citation:  Neuen, Brendon L., et al. Factors Associated with Patency Following Angioplasty of Hemodialysis Fistulae. J Vasc Interv Radiol 2014: 25:1419-1426.


Post Author: Menaka Nadar, MD