THE PERCUTANEOUS TREATMENT OF ANGIOACCESS GRAFT COMPLICATIONS

BACKGROUND: In the last decade, percutaneous techniques have been used with increasing frequency to treat angioaccess graft complications. T he role of these procedures and their outcomes in patients on hemodial ysis remains unclear. PATIENTS AND, METHODS: The records of all patien ts receiving percutaneous treatment of failed or failing angioaccess g rafts were reviewed. Patient demographics, site and type of percutaneo us intervention, and results of treatment were recorded. Survival curv es were plotted using the Kaplan-Meier method, and differences in time s to first failure between types of intervention were tested using the log rank method. RESULTS: Grafts not requiring thrombolysis had signi ficantly higher patency rates than those that did (P < 0.0001). Patenc y of grafts undergoing angioplasty of sites remote from the venous ana stomosis were significantly higher than those of grafts undergoing ven ous anastomotic dilatation (P = 0.0004). CONCLUSIONS: Percutaneous tec hniques are most effective in treating failing but patent angioaccess grafts, especially those with stenoses remote from the venous anastomo sis. The efficacy of percutaneous techniques diminishes significantly when used to treat grafts that have progressed to occlusion.