[Surgical interventions in dialysis fistulae].

PURPOSE: To evaluate the efficacy, feasibility and safety of interventional procedures in patients with hemodialysis shunts in retrospective analysis. We report the technical success rate and the midterm primary and secondary patency rate in our patients.

MATERIAL AND METHODS: Between April 1996 and May 1999 (35 months) we performed 129 interventional procedures on hemodialysis shunts in 87 patients (40 women and 47 men in age 22-88 years, mean age 67 years). We treated 46 occlusions and 83 stenoses. There were native fistulas--63 radiocephalic fistulas, 7 brachiocephalis fistulas, 1 brachiobasilic fistula, and hemodialysis grafts--14 vein allografts and 2 synthetic PTFE grafts. Indication for fistulography and intervention was decreasing efficacy of hemodialysis (in case of stenosis) or shunt occlusion. Patients were treated by means of percutaneous transluminal angioplasty, thrombolysis and percutaneous mechanical thrombectomy with hydrolyser or with thrombectomy basket. Stents were placed twice. Once in suboptimal result of local thrombolysis, second time in case of central venous stenosis. Follow up ranged from 0.3 to 35 months (mean 11 months). Nine patients were lost for follow up, 15 patients died during follow up.

RESULTS: Overall technical success rate was 84% (108 procedures, n = 129), technical success in cases of occlusion was 57% (27 procedures, n = 46), in stenoses treatment was 98% (81 procedures, n = 83). Overall primary patency rate in 6 months is 40% (n = 59), in 12 months 24% (n = 59) and in 2 years 5% (n = 59). The primary assisted patency rate and secondary patency rate is 95% (n = 59) in 6 months, 88% (n = 59) in one year and 73% (n = 59) in two years.

CONCLUSION: Repeated percutaneous interventional procedures in patient with hemodialysis shunts can extent shunt patency. Despite relatively low primary patency rate we can achieved good primary assisted or secondary patency rate in patients with stenoses of shunt.