1Mohamed Redha Saker,1Sebti Draouat
Native arteriovenous fistula (AVF) is the vascular access of choice for chronic hemodialysis patients because of its longevity and low rate of complications which are dominated by stenosis. Ultrasound-guided angioplasty of peripheral AVF stenosis in hemodialysis patients constitutes a minimally invasive percutaneous endovascular therapeutic alternative intended to restore a vascular caliber satisfactory for the correct functioning of the AVF.
Material(s) and Method(s):
Our study is prospective for evaluation of a series of 24 patients with end-stage chronic renal failure, hemodialysis and who present with stenosis of the AVF drainage vein, treated in the interventional radiology department of the Benbadis hospital in Constantine, over a period of 23 months from December 2019 to October 2021. The patients included had a significant stenosis ≥ 50% compared to the adjacent segment considered normal associated with a low flow of the AVF. All the patients in our study underwent
Doppler ultrasound exploration of the AVF before and after ultrasound-guided angioplasty. We performed 36 angioplasties in 24 patients without fluoroscopic guidance or contrast product and analyzes were performed using Microsoft Excel software.
A total of 36 angioplasties performed in 24 included patients, aged on average 51.08 ± 14.25 years with a slight female predominance and a sex ratio of 0.85. Risk and comorbid factors are dominated by hypertension (95.8%), diabetes (20.8%) and tobacco (25%). The age of AVF varies between 1 and 7 years, 100% of native AVF (n=24), 50% of fistulas are proximal (n=12) and the other half are distal, 50% are radiocephalic, 41.7% brachiorocephalic (n=10) and 8.3% brachiobasilic (n=2), 75% of patients (n=18) presented a low flow of the AVF and 62.5 % (n=15) of prolonged bleeding time. 45.8% of the stenosis were juxta-anastomotic, 41.7% post-anastomotic and 20.8% of the cephalic arch. In 58.3% the catheterization was retrograde. We used very high pressure (40 atm) expansion balloons in 50%. All angioplasties are performed with 100% technical success. Percentage increase in caliber is 115.13 ± 40.88% and that of increase in AVF flow rate is 156.13 ± 77.28%. The percentage of minor complications that occurred during the 36 angioplasties was 5.55% (n=2) represented by partial vein thrombosis and a small parietal hematoma. The average time required for an ultrasound guided angioplasty is 40 minutes.
Exclusive ultrasound guidance angioplasty of peripheral AVF stenosis is a feasible, effective and safe technique, allowing vital venous capital to be preserved for hemodialysis patients while hoping for definitive treatment of IRCT by renal transplantation.