PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY AND INTRAVASCULAR STENTS IN THETREATMENT OF CENTRAL AND PERIPHERAL STENOSES OF ARTERIOVENOUS-FISTULAS FOR CHRONIC-HEMODIALYSIS

Background: The maintenance of permeable vascular accesses in chronic hemodialysis patients is a major challenge. Aim: To report our experie nce in the percutaneous treatment of venous stenoses of arteriovenous fistulae for hemodialysis. Patients and methods: We studied retrospect ively 48 patients with arteriovenous fistulae stenoses, that were foll owed during 24 months. When the fistulography disclosed an stenosis, a percutaneous transluminal angioplasty was performed. If indicated, an intravascular stent was installed or thrombolysis was done. These pro cedures were repeated as needed. Results: Twenty four patients had a p eripheral vein stenosis, 20 had subclavian vein stenosis and 4 had bot h veins compromised. All were dilated with percutaneous transluminal a ngioplasty. Five stents were installed in the subclavian vein and five in peripheral veins. Two patients required thrombolysis. The procedur e was successful in 96% of peripheral lesions and 92% of central lesio ns. There was regression of superior limb edema in 16 of 20 patients. Five patients had an hematoma in the puncture site. Twelve months late r, 61% of treated peripheral and 42% of subclavian treated veins remai ned patent. Conclusions: the use of percutaneous transluminal angiopla sty and intravascular stents, maintains long term arteriovenous fistul ae permeability and has similar results to surgical procedures.