Long-term efficacy and risk factors of balloon-assisted maturation for radial-cephalic arteriovenous fistula with small-caliber veins.

INTRODUCTION: Balloon angioplasty maturation (BAM) is a salvage method for autologous arteriovenous fistula (AVF) maturation failure. AVF creation using small-diameter veins is considered to have poor outcomes. Therefore, this study aimed to explore the long-term patency of small-diameter veins (≤3 mm) using BAM. METHODS: BAM was performed if the fistula failed to mature and function adequately to provide prescribed dialysis. FINDINGS: Out of 61 AVFs, 22 AVFs successfully matured without further intervention (AVF group) and 39 AVFs failed to mature. Except for 1 patient who required peritoneal dialysis, the remaining 38 patients received salvage BAM, and 36 of those successful matured (BAM group). Kaplan-Meier analysis revealed no significant differences between the AVF and BAM groups in terms of primary functional patency (p = 0.503) and assisted functional patency (p = 0.499). Compared with the AVF group, the BAM group had similar assisted primary functional patency (1-year: 94.7% vs. 93.1%; 3-year: 88.0% vs. 93.1%; 5-year: 79.2% vs. 88.3%). In addition, there were no significant difference between groups in the duration of primary functional patency and assisted primary functional patency (p > 0.05). Multivariate analyses showed that vein diameter and number of BAM procedures were independent predictors of primary functional patency in the AVF group and BAM group, respectively. Patient with 1 mm increase in vein size had 0.13-fold probability of having decreased duration of patency (HR = 0.13, 95% CI: 0.02-0.99, p = 0.049), while patients who received two times of BAM procedures were 2.885 as likely to have decreased duration of primary functional patency (HR = 2.885, 95% CI: 1.09-7.63, p = 0.033) than patients who received one BAM procedure. DISCUSSION: BAM is a relatively effective salvage management option with an acceptable long-term patency rate, even for small cephalic veins.

High pulse pressure predicts primary arteriovenous fistula failure within 1 year.

BACKGROUND: The arteriovenous fistula is the preferred access route for hemodialysis, although its high primary failure rate remains a clinical challenge. Multiple studies have attempted to determine the risk factors for primary arteriovenous fistula failure; however, none have identified pulse pressure as a potential predictive marker. High pulse pressure is a surrogate poor arterial compliance endpoint and leads to inferior cardiovascular outcomes. Our aim was to determine whether elevated pulse pressure indicates poor arteriovenous fistula maturation. METHODS: We retrospectively reviewed 274 patients who underwent an arteriovenous fistula index operation between September 1, 2018 and May 31, 2019. Demographic, clinical data, and operative parameters were collected and analyzed. The maximum follow-up period was 365 days. Arteriovenous fistula failure was defined as the inability to achieve functional use during the follow-up period. We identified risk factors for arteriovenous fistula failure by performing a multivariate logistic regression analysis using backward elimination procedures. RESULTS: A total of 274 patients were included in the study. The patients' average age was 61.3 ± 14.0 years, approximately half of the patients (n = 161, 58.8%) were male, and the majority had hypertension. At the end of the follow-up period, 68 (24.8%) had arteriovenous fistula failure. The proportion of patients with pulse pressure values of >60 mmHg was significantly higher in the failure group than in the maturation group (66.0% vs 80.9%; p = 0.021). A PP value of >60 mmHg (odds ratio = 2.25; 95% confidence interval = 1.14-4.42; p = 0.019) and coronary artery disease or myocardial infarction (odds ratio = 1.97; 95% confidence interval = 1.01-3.84; p = 0.045) were found to be independent risk factors for primary arteriovenous fistula failure. CONCLUSIONS: High pulse pressure is an independent risk factor for primary arteriovenous fistula failure.

The clinical outcome of balloon-assisted maturation procedure between autogenous radiocephalic fistula and brachiocephalic fistula in a single-center experience.

OBJECTIVE: Balloon-assisted maturation (BAM) by an endovascular method plays an important role in treating an immature arteriovenous fistula. However, the results between radiocephalic fistula and brachiocephalic fistula were rarely reported. This retrospective study aimed to investigate the effectiveness and outcome of BAM in different sites of autogenous arteriovenous fistulas. METHODS: This single-center retrospective study included patients who underwent BAM procedures from January 2015 to December 2016. Of 148 patients, 117 and 31 patients had a radiocephalic fistula (RC) and a brachiocephalic fistula (BC), respectively. The primary outcome was BAM success. Data regarding fistula lesions, balloon types and size, frequency of procedures, and maturation time were collected for BAMs. The secondary outcome was the patency of a fistula in the follow-up period. RESULTS: No difference was observed in procedure of BAM frequency between the RC and BC groups. The total success rate was 77.7%, without significant difference between the RC and BC groups (81.20% vs 64.50%; P = .055). Within the procedures, the culprit lesion of juxta-anastomosis segment (73.5% vs 25.5%; P < .001) and arterial inlet (21.2% vs 7.8%; P = .04) were more common in the RC group, whereas the venous outlet was more common in the BC group (88.2% vs 57.7%; P < .001). Both groups had an equivalent patency rate after the BAM within the follow-up period (P = .272). CONCLUSIONS: BAM was an effective procedure for immature fistulas, without significant difference between RCs and BCs. Through the procedure, the culprit lesions causing non-maturation were found to be different between the two groups. The patency rate between the two groups after surgery seems to be equivalent within the follow-up period.

Total Resection of Infected Peripheral Hemodialysis Grafts Has a Favorable Impact on Outcomes.

BACKGROUND: Surgical resection could be an eradication treatment for patients with infected hemodialysis arteriovenous grafts (AVGs). This study aimed to investigate the outcomes of 3 surgical methods, including total resection, subtotal resection, and revision. METHODS: The patients who underwent surgical excision of infected AVGs performed at a single center from August 2012 to March 2019 were retrospectively analyzed. The following 3 surgical methods were used in our study: revision, subtotal resection, and total resection. Patients' demographics, medical history, perioperative details, reconstruction time, and follow-up data were collected. The outcomes including perioperative complications (within 30 days), mortality, reinfection rate of AVGs, with new access reconstruction or not, and the outcomes between reconstruction and nonreconstruction in the follow-up period were evaluated. RESULTS: Forty-one patients had infected AVGs in our study. Patients' mean age was 62 years, and 65.9% of the patients were female. The mean duration from the time of diagnosis to the operation was 14.4 days. Signs and symptoms at presentation included fever (51.2 %), swelling (43.9%), pain (58.5%), erythematous change (92.7%), and more severe features, such as altered consciousness (14.6%) and hypotension (12.2%). The pathological changes in the infected grafts included bleeding (29.3%), pus formation (73.2%), pseudoaneurysm (26.8%), and graft exposure (17.1%). Wound and graft cultures revealed an infectious etiology with fungi (7.3%), Pseudomonas aeruginosa (12.2%), Enterococcus spp. (2.4%), and Staphylococcus spp. (58.5%), with methicillin-resistant Staphylococcus aureus accounting for only 7.3%. Total resection, subtotal resection, and revision surgery were performed in 17.1%, 63.4%, and 19.5% of patients, respectively. Seven patients with complications required reoperation (17.1%), and adhesion ileus and hospital-acquired pneumonia occurred in only 2.4% and 7.3% of patients, respectively. During follow-up, most patients (82.9%) had reconstruction of the peripheral hemodialysis access with mean time of 64.3 (range: 21-92) days; mean time of use of new access was 90.5 days; and mean time of removal of catheter was about 106.3 days. Mortality rates in patients without and with reconstructed AV access during follow-up were 50% and 18%, respectively (P < 0.004). Eight cases (19.5%) had recurrence of AV access infections during follow-up; of these, 2 had revision surgery and 6 had subtotal resection. However, no patient with total resection had recurrent infections. CONCLUSIONS: The total resection group had no recurrent infection compared to the subtotal and revision groups. In addition, patients with reconstruction of peripheral hemodialysis access had a low mortality rate during the follow-up period.

Correction: Optimal paramedic numbers in resuscitation of patients with out-of-hospital cardiac arrest: A randomized controlled study in a simulation setting.

[This corrects the article DOI: 10.1371/journal.pone.0235315.].

Optimal paramedic numbers in resuscitation of patients with out-of-hospital cardiac arrest: A randomized controlled study in a simulation setting.

BACKGROUND: The effect of paramedic crew size in the resuscitation of patients with out-of-hospital cardiac arrest (OHCA) remains inconclusive. We hypothesised that teams with a larger crew size have better resuscitation performance including chest compression fraction (CCF), advanced life support (ALS), and teamwork performance than those with a smaller crew size. METHODS: We conducted a randomized controlled study in a simulation setting. A total of 140 paramedics from New Taipei City were obtained by stratified sampling and were randomly allocated to 35 teams with crew sizes of 2, 3, 4, 5, and 6 (i.e. 7 teams in every paramedic crew size). A scenario involving an OHCA patient who experienced ventricular fibrillation and was attached to a cardiopulmonary resuscitation (CPR) machine was simulated. The primary outcome was the overall CCF; the secondary outcomes were the CCF in manual CPR periods, time from the first dose of epinephrine until the accomplishment of intubation, and teamwork performance. Tasks affecting the hands-off time during CPR were also analysed. RESULTS: In all 35 teams with crew sizes of 2, 3, 4, 5, and 6, the overall CCFs were 65.1%, 64.4%, 70.7%, 72.8%, and 71.5%, respectively (P = 0.148). Teams with a crew size of 5 (58.4%, 61.8%, 68.9%, 72.4%, and 68.7%, P<0.05) had higher CCF in manual CPR periods and better team dynamics. Time to the first dose of epinephrine was significantly shorter in teams with 4 paramedics, while time to completion of intubation was shortest in teams with 6 paramedics. Troubleshooting of M-CPR machine decreased the hands-off time during resuscitation (39 s), with teams comprising 2 paramedics having the longest hands-off time (63s). CONCLUSION: Larger paramedic crew size (≧4 paramedics) did not significantly increase the overall CCF in OHCA resuscitation but showed higher CCF in manual CPR period before the setup of the CPR machine. A crew size of ≧4 paramedics can also shorten the time of ALS interventions, while teams with 5 paramedics will have the best teamwork performance. Paramedic teams with a smaller crew size should focus more on the quality of manual CPR, teamwork, and training how to troubleshoot a M-CPR machine.

A prospective randomized study of stent graft placement after balloon angioplasty versus balloon angioplasty alone for the treatment of hemodialysis patients with prosthetic graft outflow stenosis.

BACKGROUND: Hemodialysis graft outflow stenosis is a significant complication occurring in hemodialysis patients with prosthetic grafts for vascular access. Balloon angioplasty remains the first-line endovascular treatment of this complication, although covered stent graft implantation after balloon angioplasty also appears to be an effective and promising treatment. The aim of this study was to evaluate the efficacy and durability of stent graft placement after balloon angioplasty in comparison to balloon angioplasty alone for the treatment of graft outflow stenosis in hemodialysis patients. METHODS: We conducted a prospective randomized study of 98 patients with clinically significant dialysis graft outflow stenosis treated in the vascular surgery section of a tertiary medical center. The patients were randomized into two groups; 49 patients were treated with stent graft placement after balloon angioplasty, and 49 patients were treated with balloon angioplasty alone. All patients underwent angiography of the graft site at 3 and 6 months after intervention, and restenosis rates were compared between the two groups. In addition, the duration of postintervention primary patency in the two groups was recorded and analyzed. RESULTS: The postintervention restenosis rate of the stent graft placement group was superior to that seen in the balloon angioplasty alone group (9% vs 69% at 3 months [P < .0001] and 29% vs 72% at 6 months [P < .0001]). The mean postintervention primary patency duration was 380.22 ± 28.54 days for the stent graft placement group and 151.08 ± 16.79 days for the balloon angioplasty alone group (P < .0001). CONCLUSIONS: The use of stent grafts in hemodialysis patients with graft outflow stenosis yielded superior results compared with the results seen in hemodialysis patients treated with balloon angioplasty alone. Patients treated with stent grafts after balloon angioplasty had a lower restenosis rate and a longer duration of postintervention primary patency. The placement of a stent graft after balloon angioplasty appears to be an optimal therapeutic approach for the treatment of hemodialysis patients with graft outflow stenosis.

Dose Intraoperative Fluoroscopy Precisely Predict Catheter Tip Location via Superior Vena Cava Route?

Adequate catheter tip location is crucial for functional intravenous port and central venous catheter. Numerous complications were reported because of catheter migration that caused by inadequate tip location. Different guidelines recommend different ideal locations without consensus. Another debate is actual movement of intravascular portion of implanted catheter. From literature review, the catheter migrated peripherally an average of 20 mm on the erect chest radiographs. In this study, we want to verify the actual presentation of catheter movement within a vessel and try to find a quantitative catheter length model to recommend.From March 2012 to March 2013, 346 patients were included into this prospective cohort study. We collect clinical data from medical record and utilized picture archiving and communication system to measure all image parameters. Statistical analysis was utilized to identify the risk factors for catheter migration.The nonmigration group had 221 patients (63.9%); 67 (19.4%) patients were classified into the peripheral migration group; and 58 (16.8%) patients were classified into the central migration group. Patients with short height (P = 0.03), larger superior vena cava (SVC) diameters at the brachiocephalic vein confluence site (P = 0.02), and longer implanted catheter length (P = 0.0004) had greater risks for central migration. We utilized regression curve for further analysis and height (centimeters)/10 had moderate correlation distances from the entry vessel to the carina.Although intravascular movement of catheter was exist in implanted catheter, the intraoperative fluoroscopy could provide accurate catheter tip location in 63.9% patients. Additional length of catheter implantation seems unnecessary in 80.6% patients. Patients with short height, larger SVC diameters at the brachiocephalic vein confluence site had greater risk for catheter central movement. Height/10 may be consider as reference length of implantation for inexperience surgeon and precise implantation length could be adjust under guidance of fluoroscopy.

Pleural Empyema and Aortic Aneurysm: A Retrospective National Population-Based Cohort Study.

Pleural empyema (PE) may evolve into necrosis, fistula in the thorax, and sepsis; thus, it is also associated with high mortality.We investigated and analyzed the risk of aortic aneurysm (AA) in a cohort study of patients with PE.A total of 34,250 patients diagnosed with PE were identified as the PE cohort, and 137,000 patients without PE were selected randomly as the control group and matched by sex, age, and index year of PE diagnosis. Patients ages 20 years and younger with a history of AA were excluded. The risk of AA was analyzed using a Cox proportional hazards regression model.Excess risk of AA development was 1.69-fold higher in PE patients (adjusted hazard ratio [aHR] = 1.69; 95% confidence interval [CI] = 1.39-2.05) compared with non-PE patients. The patients with PE exhibited a greater adjusted risk of AA (aHR = 2.01; CI = 1.44-2.81) even if they did not have any of the 9 comorbidities included in our analysis (diabetes, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, heart failure, cardiac artery disease, stroke, bacterial endocarditis, and rheumatic endocarditis). Compared with the patients without any of the 9 comorbidities or PE, the patients with only PE had a greater risk of developing AA (aHR = 2.00; CI = 1.43-2.79). The PE cohort had a significantly higher cumulative incidence of AA than the non-PE cohort did during 12 years of follow-up.In a large-scale cohort, patients with PE are linked with an increased risk of AA.

The Treatment Results of a Standard Algorithm for Choosing the Best Entry Vessel for Intravenous Port Implantation.

Vascular cutdown and echo guide puncture methods have its own limitations under certain conditions. There was no available algorithm for choosing entry vessel. A standard algorithm was introduced to help choose the entry vessel location according to our clinical experience and review of the literature. The goal of this study is to analyze the treatment results of the standard algorithm used to choose the entry vessel for intravenous port implantation.During the period between March 2012 and March 2013, 507 patients who received intravenous port implantation due to advanced chemotherapy were included into this study. Choice of entry vessel was according to standard algorithm. All clinical characteristic factors were collected and complication rate and incidence were further analyzed.Compared with our clinical experience in 2006, procedure-related complication rate declined from 1.09% to 0.4%, whereas the late complication rate decreased from 19.97% to 3.55%. No more pneumothorax, hematoma, catheter kinking, fractures, and pocket erosion were identified after using the standard algorithm. In alive oncology patients, 98% implanted port could serve a functional vascular access to fit therapeutic needs.This standard algorithm for choosing the best entry vessel is a simple guideline that is easy to follow. The algorithm has excellent efficiency and can minimize complication rates and incidence.

Deltoid branch of thoracoacromial vein: a safe alternative entry vessel for intravenous port implantation.

An entry vessel is crucial for intravenous port implantation. A safe alternative entry vessel that can be easily explored is crucial for patients without feasible cephalic vein or for those who need port reimplantation because of disease relapse. In this study, we tried to analyze the safety and feasibility of catheter implantation via the deltoid branch of the thoracoacromial vein.From March 2012 to November 2013, 802 consecutive oncology patients who had received intravenous port implantation via the superior vena cava were enrolled in this study. The functional results and complications of different entry vessels were compared.The majority of patients (93.6%) could be identified as thoracoacromial vessel. The deltoid branch of the thoracoacromial vein is located on the medial aspect of the deltopectoral groove beneath the pectoralis major muscle (85.8%) and in the deep part of the deltopectoral groove (14.2%). Due to the various calibers employed and tortuous routes followed, we utilized 3 different methods for catheter implantation, including vessel cutdown (47.4%), wire assisted (17.9%), and modified puncture method (34.6%). The functional results and complication rate were similar to other entry vessels.The deltoid branch of the thoracoacromial vein is located in the neighborhood of the cephalic vein. The functional results of intravenous port implantation via the deltoid branch of the thoracoacromial vein are similar to other entry vessels. It is a safe alternative entry vessel for intravenous port implantation.

Analysis of chest X-ray plain film images of intravenous ports inserted via the superior vena cava.

PURPOSES: The optimal tip position for an intravenous port and the angle between the locking nut and the catheter are still debatable. This study evaluates the use of chest X-ray plain films for screening patients with potential intravenous port complications. METHODS: We reviewed, retrospectively, 1505 patients who had an intravenous port implanted between January 1 and December 31, 2006 at Chang Gung Memorial Hospital, and were followed up until June 30, 2010. Of the 1119 patients with an intravenous port implanted via the superior vena cava (SVC), 279 underwent re-interventions for complications. There were four different types of single lumen port, and entry vessels on the right side were utilized as the predominant entry sites through the vessel cut-down method for catheter cannulation. The anatomic catheter tip was confirmed on the postero-anterior view of plain chest X-ray films. We used the Picture Arching and Communicating System (PACS) (GE, Fairfield, CT, USA) to record the angle and distance in degrees and centimeters, respectively. RESULTS: The tracheal carina was seen easily on the chest X-ray plain film and the location of the catheter tip and the angle between the locking nut and the catheter were identified. The location of the catheter tip was significantly related to migration (p < 0.0001). The cut-off value of the receiver operating characteristic (ROC) curve for location and migration was 0.68 cm below the carina. The area under the curve (AUC) was 0.8385 and had favorable predictive power. CONCLUSION: The ideal position of an intravenous port to avoid migration is 0.68 cm below the carina. For surgeons, a quantified reference may minimize technical errors. Patients with shallow tip location should be followed up regularly and aggressive intervention initiated for any intravenous port malfunction.

A single-center study of vascular access sites for intravenous ports.

PURPOSE: This study evaluated the use of intravenous ports and provides a guide related to clinical decision making. METHODS: This study retrospectively reviewed 1505 patients who had received intravenous ports at Chang Gung Memorial Hospital in 2006. The relationships between the complications and entry routes were assessed. The intervention-free periods were also determined and compared. The patients were followed up until June 2010. RESULTS: Of the 1543 procedures performed, 412 were reinterventions to treat complications, most of which corresponded to fewer than 0.1 episodes per 1000 catheter-days; these were not associated with any particular entry route. There was a higher catheter fracture rate when the right subclavian vein was chosen as the entry vessel (p < 0.05). The intervention-free period ranged from 207 to 533 days. CONCLUSION: The subclavian vein is not recommended for the use of intravenous ports. There is not only a higher risk of iatrogenic pneumothorax or hemothorax using this entry route but also a higher fracture rate, which may be caused by pinch-off syndrome. The greater saphenous vein should only be considered when the patient has superior vena cava syndrome. However, a higher incidence of infection and a lower device survival rate should be expected with this location.

Risk factors and possible mechanisms of superior vena cava intravenous port malfunction.

OBJECTIVE: To identify the risk factors leading to catheter malfunction. BACKGROUND: Reliable venous access is crucial for cancer patients. Malfunction of intravenous ports may lead to discontinuation of treatment and repeated interventions. We retrospectively reviewed the independent risk factors for catheter malfunction among patients receiving intravenous port implantations. METHODS: A total of 1508 procedures were included from the calendar year 2006, and clinical data and chest plain films were analyzed. The patients were followed-up until June 30, 2010. For patients still alive, the last outpatient follow-up date was considered as the end point. For the remaining patients, the date of death or discharge against advice was considered as the end points. The risk factors for catheter malfunction were then evaluated. RESULTS: The intervention-free periods of the malfunction group and nonmalfunction group were 317 and 413 days, respectively. Statistical analyses showed that the Nut-Catheter Angle was the only risk factor for catheter malfunction (P = 0.001). A logistic model also confirmed that the Nut-Catheter Angle was the only risk factor for catheter malfunction (P < 0.001). Valve tip catheters were not advantageous with regard to catheter malfunction prevention as compared to open tip catheters. CONCLUSIONS: A smaller Nut-Catheter Angle had a greater risk for catheter malfunction. Catheter impingement caused by inadequate pocket creation and port implantation lead to compromised catheter lumen and difficulty flushing. The possibility of retained blood and medications increased thin thrombotic biofilm formation and medication precipitation. Catheter malfunctions can be avoided by using proper surgical techniques and adequate maintenance.

Predictors of outcome after open repair of ruptured abdominal aortic aneurysms.

BACKGROUND: To determine predictors associated with early hospital death, 30-day mortality, and long-term survival after open surgical treatment of ruptured abdominal aortic aneurysms (RAAAs). METHODS: A retrospective chart review of 127 consecutive patients who received open surgical treatment of a RAAA at Chang Gung Memorial Hospital, Taiwan, from February 1994 to May 2007. Data recorded included patient characteristics, medical history, perioperative variables, and outcomes. RESULTS: There were 104 men and 23 women with a mean age of 70 ∓ 12 years in the analysis. Patients with RAAAs were classified into two groups; 100 (78.7%) patients were classified as group I (hemodynamically stable), and 27 (21.3%) patients were classified as group II (hemodynamically unstable at arrival). The 30-day mortality was 22% for group I and 74.1% for group II. Multivariate analysis identified age > 75 years old (odds ratio [OR], 0.083; 95% confidence interval [CI] 0.02-0.36), hemodynamically unstable state (OR, 0.081; 95% CI 0.016-0.4), blood transfusion > 5 L (OR, 0.14; 95% CI 0.038-0.54), intraperitoneal rupture (OR, 7.2; 95% CI 1.4-36), urine output < 0.5 mL/kg/min (OR, 22; 95% CI 4.6-110), and suprarenal cross-clamping (OR, 0.083; 95% CI 0.019-0.36) as incremental risk factors for 30-day mortality. CONCLUSION: Significant predictors of mortality in patients with RAAAs include hemodynamically unstable state, age > 75 years old, intraperitoneal rupture, low intraoperative urine output, and suprarenal cross-clamping.

Catheter fracture of intravenous ports and its management.

BACKGROUND: Intravenous ports are widely used for oncology patients. However, catheter fractures may lead to the need for re-intervention. We aimed to identify the risk factors associated with catheter fractures. METHODS: Between January 1 and December 31, 2006, we retrospectively reviewed the clinical data and plain chest films of 1,505 patients implanted with an intravenous port at Chang Gung Memorial Hospital. Different vascular sites were compared using the chi-square or Fisher's exact test for categorical variables, and the t test was used for continuous variables with normal distribution; P < 0.05 was considered statistically significant. RESULTS: There were 59 and 1,448 procedures in the fracture and non-fracture groups, respectively. Monovariate analysis revealed that the risk factors for catheter fracture were as follows: large angle (P < 0.0001), female gender (P < 0.0008), subclavian route (P < 0.0001), and port type Arrow French (Fr.) 8.1 (P < 0.0001). Because these risk factors showed no interaction effects, they were all considered independent risk factors. When all factors were considered together, all risk factors, except angle and age, retained their statistical significance. CONCLUSIONS: Most catheter fractures were caused by material weakness. If catheter fracture is confirmed, further intervention for port and catheter removal is recommended. Female gender, intravenous port implantation via the subclavian route, and the Arrow Fr. 8.1 port were found to be risk factors. Patients with these risk factors should be monitored closely to avoid catheter fractures.

Balloon angioplasty versus surgical revision for thrombosed dialysis graft outlet stenosis after graft thrombectomy.

BACKGROUND: It is important to correct underlying graft outlet stenosis after thrombectomy of dialysis grafts. This study retrospectively reviewed patients who received dialysis graft thrombectomy at this institution to compare the effectiveness of 2 different methods. METHODS AND RESULTS: A total of 289 dialysis graft thrombectomy procedures performed during 2001-2003 were retrospectively reviewed. The results of 163 cases in balloon angioplasty group were compared with those of 129 patients who underwent outlet revision. Patient characteristics between the 2 groups were similar with regard to demographic characteristics and comorbidities (P > .05). The mean primary patency of balloon and revision groups are 7.23 +/- 7.38 and 8.35 +/- 9.53 (months), respectively. Survival curves for each group were calculated by Kaplan-Meier method. There was no difference between 2 groups regarding graft patency. CONCLUSIONS: The result of dialysis graft outlet balloon angioplasty was comparable to that of surgical revision. Considering the invasiveness, balloon angioplasty should be considered when treating thrombosed dialysis grafts.