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J Vasc Access ; 13(3): 381-7, 2012.
Article in English | MEDLINE | ID: mdl-22367648

ABSTRACT

PURPOSE: Endovascular procedures have been increasingly used for salvage of failing vascular access with conflicting results. The aim of this study was to assess the mid-term patency and complication rates of angioplasty procedures performed in a single center for treatment of stenosis compromising vascular accesses. METHODS: A prospective database of vascular accesses performed in 2006-2010 was investigated. The endovascular approach was applied following a standardized protocol by a dedicated team. A total of 531 consecutive procedures were reviewed (326 men; mean age 70.94 years). Patency rates were estimated using the Kaplan-Meier method. RESULTS: There were 199 procedures for failing access: 135 were surgical and 64 angioplasties performed for anastomosis (n=27), venous (n=45) or arterial (n=7) stenosis. Immediate technical success of endovascular procedures was 95.3%(61/64); complication rate was 6.3% (4/64). Primary patency rates were 55% at six months, 49% at 12 months, and 21% at 24 months. In the concurrent group of 135 open procedures, primary patency rates were 80% at six months and 67% at 12 months (P=.002); nevertheless, at 24 months, patency was as low as 49%. Cost estimates for angioplasty revealed additional fees ranging from 411.34 to 446.34 Euro with respect to open surgical procedures. CONCLUSIONS: Most dysfunctional vascular accesses can be successfully and safely treated by the endovascular route. In spite of poor mid-term durability, the angioplasty balloon might be considered as a bridge, effective, and repeatable solution with reasonable costs to prolong access survival avoiding additional surgery. The failure rate in the mid-term for dysfunctional vascular access may also be high after surgical reintervention.


Subject(s)
Angioplasty, Balloon , Arteriovenous Shunt, Surgical/adverse effects , Graft Occlusion, Vascular/therapy , Renal Dialysis , Adult , Aged , Aged, 80 and over , Angioplasty, Balloon/adverse effects , Angioplasty, Balloon/economics , Arteriovenous Shunt, Surgical/economics , Constriction, Pathologic , Female , Graft Occlusion, Vascular/diagnostic imaging , Graft Occlusion, Vascular/economics , Graft Occlusion, Vascular/etiology , Graft Occlusion, Vascular/physiopathology , Health Care Costs , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Prospective Studies , Radiography , Renal Dialysis/economics , Reoperation , Time Factors , Treatment Outcome , Vascular Patency , Young Adult
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