Evaluation of the

Endovascular salvage outcome

for dysfunctional hemodialysis

arteriovenous fistula

according to the site of the

lesion

Usama Ali Lotfi, MD, MRCS.

Professor of vascular surgery. Cairo University

Hesham Mostafa Abdulsamad, MD.

Professor of vascular surgery. Cairo University

Disclosure

Prof. Usama Ali Lotfi , MD, MRCS .................................................................................

I have the following potential conflicts of interest to

report:

Consulting

Employment in industry

Stockholder of a healthcare company

Owner of a healthcare company

Other(s)

I do not have any potential conflict of interestX

Background

Among the available hemodialysis accesses, native AVF

stands as the option with better overall patency and

lower complication rates.

Dysfunctional AVF (Failed to mature, Significant

stenosis, or inefficient HD) represents a major cause of

morbidity, mortality, and significant HD care-related

costs.

Until the near past, AVF dysfunction means a new

access, numerous procedures to maintain HD and

eventual exhaustion of all access sites; Until the

evolution of endovascular techniques.

Functionally significant

stenosis

Reduction of normal vessel diameter (>50%) accompanied by a hemodynamic or clinical abnormality

Clinical parameters Inability of access puncture, change in thrill

propagation, swollen extremity, prolonged bleeding after needlewithdrawal, or thrombosis.

Duplex evidence of poor intra-access blood flow.

Poor HD parameters: - Elevated venous pressures.

-Elevated -ve arterial pre-pump pressures.

-Unexplained reduction in dialysis kinetics.

- Abnormal recirculation values.

The site of lesion responsible

for AVF dysfunction

- Arterial

- Anastomotic

- Venous

- Pathology

- Clinical presentation

- Treatment

The aim of this study

The impact of the site of the lesion(s) tackled

The immediate and delayed outcomes

of endovascular salvage of dysfunctional AVFs

In terms of - Technical success

- 6 month patency rate

Significant improvement in the management plan

Patients & Methods

Kasr El Aini - Cairo University hospitals.

Prospective study from January 2012 - 2015.

253 HD patients with dysfunctional native AVFs. (Radiocephalic, brachiocephalic, or brachiobasilic fistulas)

Exclusion criteria:

• Persistent hypotension.

• Associated infection.

• Overlying skin integrity disruption.

• Known contrast allergy.

Patients & Methods

Arterial

• Proximal

• Juxta-anastomotic

• Anastomotic

Venous

• Juxta-anastomotic

• Needling segment

• Cephalic arch

• Central

Results

Results

Results

Results

Results

The parameters of successful procedure1) Anatomic success:Restoration of luminal diameter with residual stenosis ˂30%.2) Clinical success:Improvement of clinical parameters with at least 3 HD sessions.3) Hemodynamic success:Restoration of hemodynamic parameters (PSVR˂2)

Results

Results

Follow up for a minimum of 6 months (n=231).

30 AVFs had to be abandoned due to occlusion or dysfunction.

77 Re-PTA in 58 AVFs. Single (n=25) or multiple (n= 33).

conclusions

The site of the lesion has an impact on both

immediate technical success, and later patency

rates following PTA of dysfunctional AVFs.

Arterial and central venous lesions have the

least success and patency rates.

Unfavorable rates are not an invitation to

regret salvage. As PTA can be repeated.

the use of suitable tools and techniques can

optimize the results according to each lesion

site.

Thank you

Evaluation of the

Endovascular salvage outcome

for dysfunctional hemodialysis

arteriovenous fistula

according to the site of the

lesion

Usama Ali Lotfi, MD, MRCS.

Professor of vascular surgery. Cairo University

Hesham Mostafa Abdulsamad, MD.

Professor of vascular surgery. Cairo University