The Usefulness of Wire-Loop Technique for Percutaneous Angioplasty of Insufficient Hemodialysis Fistula

ABSTRACT

PURPOSE: To evaluate the usefulness of the Wire-Loop technique, used to perform percutaneous transluminal angioplasty (PTA) in occluded arteriovenous fistula when standard methods fail to pass the balloon catheter. MATERIALS AND METHODS: In 30 patients [MF=1416; aged 27 -77 (mean, 51.3) years], the Wire-Loop technique was used to perform percutaneous transluminal angioplasty of insufficiently hemodialysed arteriovenous fistula where a balloon catheter had failed to pass through the stenotic lesion after a guide wire had successfully passed. Native and Goretex fistula were used in 22 and eight cases, respectively. Sixteen stenoses were located in the central vein, and fourteen in the peripheral. The punture sites used in order to perform the technique were the femoral vein in all cases of central stenosis; three basilic, four cephalic, and five femoral veins in cases of peripheral stenosis and one femoral and one radial artery in cases of anastomotic stenosis. The guide wire was passed through the stenotic lesion, pulled out using the snare technique, and then stretched in order to tighten it. The balloon catheter was then passed through the lesion and traditional balloon angioplasty was performed. The technical success rate and complications of the technique, and the patency rate of recanalized arteriovenous fistula, were evaluated. RESULTS: In 26 of the thirty patients, (86.7%), the procedure was technically successful. In the remaining four cases, failure was due to venous dissection (n=1), marked residual stenosis (n=2), or cardiac arrest (n=1) during the procedure. The average procedure time was 105 (range, 40 -210) minutes, and in three cases rupture of the vein occurred. The patency rate of PTA was 80% (24/30) at four months, 63% (19/30) at six months, and 30% (9/30) at twelve months. The expected technical success rate of traditional PTA, without the Wire-Loop technique, would have been 79.3%, but using the technique, the rate increased to 86.7%. CONCLUSION: The Wire-Loop technique appears to be a safe and valuable procedure in patients with insufficiently hemodialysed arteriovenous fistula, and is therefore useful in cases in which traditional PTA fails.