Results of endovascular treatment of venous anastomotic stenosis in prosthetic arteriovenous for hemodialysis PTFE grafts. Comparative analysis between patent and occluded grafts

Nefrologia (Engl Ed) . 2021 Aug 11;S0211-6995(21)00147-8. doi: 10.1016/j.nefro.2021.03.015. Online ahead of print.

Fecha de la publicación: 11/08/2021

Autor: Ferrán Plá Sánchez (1), Guillermo Moñux Ducajú (2), Oscar Uclés Cabeza (3), Rodrigo Rial (2), Adriana Baturone Blanco (3), Julio Reina Barrera (3), Antonio Martín Conejero (3), Francisco Javier Serrano Hernando (3)

Palabras clave: Anastomosis, Anastomotic, Arteriovenosa, Arteriovenous, Estenosis, Graft; Prótesis, Stenosis, Stent, Thrombectomy, Trombectomía

PMID

PMID: 34391607
DOI: 10.1016/j.nefro.2021.03.015

Affiliations

¹Servicio de Angiología y Cirugía Vascular, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España. Electronic address: ferplasan@gmail.com.

²Servicio de Angiología y Cirugía Vascular, Hospital Universitario HM Torrelodones, Madrid, España.

³Servicio de Angiología y Cirugía Vascular, Hospital Clínico San Carlos, Madrid, España.

Abstract

Objective: To analyze the results of endovascular treatment of venous anastomotic stenosis (VAS) in humero-axillary arteriovenous grafts (HAG), comparing outcomes between patent and thrombosed HAG.

Material and methods: A retrospective cohort study was made of endovascular treated patients because of a VAS in a HAG between January 2009 and December 2019. Group A: Thrombosed HAG secondary to a VAS. Group B: Patent HAG with a VAS detected during follow-up. Technical success was defined as residual stenosis after treatment <30%, and clinical success as satisfactory immediate dialysis after surgery. After ET a biannual clinical and ultrasound follow-up was performed.

Statistical analysis: Survival analysis was performed for time-to-event data to assess patency.

Results: Group A: 55 patients. Group B: 22. There were no significative differences in demographic and anatomical factors between groups. Technical and clinical success were 100% in Group B and 94.5% and 91% respectively in Group A. Primary patency at 1, 6 and 12 months was: Group A: 81.8%, 22.4% and 15.7% respectively. Group B: 100%, 85.9%, 76.4% (p<0.001). Secondary patency at 1, 6 and 12 months was: Group A: 85.2%, 45.8% and 31.3% respectively. Group B 100%, 95.3%, 95.2% (p<0.001). Use of non-covered stents was associated with an increased risk of occlusion (HR 2.669 95% CI 1.146-6.216, p=0.010).

Conclusion: A higher patency of EV performed on a patent HAG is expected. It is therefore advisable to develop surveillance programs that are capable to detect VAS before its occlusion.