TRANSLUMINAL PERCUTANEOUS ANGIOPLASTY IN THE TREATMENT OF ARTERIOVENOUS-FISTULA STENOSIS

To maintain safe vascular access for hemodialysis is one of the main o bjectives in nephrology. Nowadays, autologous or heterologous arteriov enous fistulas are the first choice, and to prolong their survival is a priority in the nephrologist's daily clinical practice. The developm ent of transluminal percutaneous angioplasty allows us to treat fistul a stenosis and to prevent the development of trombosis. The aim of thi s study is to review our experience in the early diagnosis oi fistula stenosis and its treatment with transluminal percutaneous angioplasty through a period of 21 months highlighting the patency rates obtained in this interval of time. Twenty-nine angioplasty procedures were perf ormed on twenty fistulas of nineteen patients (ten male, nine female). Fourteen fistulas were autologous and six heterologous. By maintainin g close hemodynamic monitoring we were able to diagnose the stenosis b ecause of a decrease in blood flow in a 52% of cases, an increase in v enous pressure in a 31% and because of recirculation in the rest (17%) . The clinical suspicion was confirmed in all cases, using doppler stu dies and angiography in 73% of cases and angiography alone in the rest angioplasty was then performed. A median of 1,48 +/- 0,82 procedures were performed per fistula (minimum 1, maximum 4). Two cases required a stent placement because or frequent re-stenosis. With the Kaplan-Mei er method, we have calculated the patency rates of the fistulas after being dilated by angioplasty. The primary radiologic patency rate of a dialysis shunt after one angioplasty procedure was 67% at 21 months, increasing to 80% ii the fistula was dilated as many times as needed b ecause of re-stenosis (secondary radiologic patency rate). Consequentl y, we conclude that transluminal percutaneous angioplasty is a useful method to prolong the survival of arteriovenous shunts if it is perfor med son after the hemodynamic monitoring indicates the development of a stenosis.