Femoral Arter: Disfonksiyonel Arteriovenöz Fistüllerin Anjiyografik Tedavisinde Alternatif Bir Kanülasyon Lokalizasyonu. Tek Merkez Deneyimi

Öz

Endovasküler girişimler, disfonksiyonel arteriovenöz fistüllerin (AVF) tedavisinde en sık kullanılan tedavi modaliteleri olsa da optimal ponksiyon yeri konusunda bir fikir birliği yoktur. Bu retrospektif, tek merkezli çalışmada, femoral arter yoluyla disfonksiyonel AVF'lere yönelik endovasküler girişimlerin kısa vadeli klinik başarı oranlarını ve komplikasyonlarını sunuyoruz. Ocak 2016 ile Aralık 2019 arasında AVF disfonksiyonu tanısı alan ve bu nedenle perkütan transluminal anjiyoplasti (PTA) uygulanan toplam 29 hemodiyaliz hastası bu çalışmaya dahil edildi. Tüm PTA'lar aynı deneyimli girişimsel kardiyolog tarafından yapıldı. Hastaların demografik, klinik verileri, birincil açıklık ve işlem komplikasyonlarına ilişkin veriler hastane veri tabanından ve/veya hastanın kendi hemodiyaliz merkezinin elektronik kayıtlarından elde edildi. İşlem sonrası “thrill”in saptanması, başarılı kanülasyon ve tedaviden hemen sonra yeterli hemodiyaliz yapılabilmesi klinik başarı olarak kabul edildi. Toplam 29 hemodiyaliz hastasına AVF disfonksiyonu nedeniyle PTA uygulandı. Hastaların ortanca yaşı 61 (IQR 55.0-68.0) olup, %72.4'ü erkekti. Hastaların %41'i diyabetikti. Ortanca AVF yaşı 44.0 (24.0-92.0) aydı. Jukstaanastomotik (%48.3) ve efferent ven darlığı (%37.9) AVF işlev bozukluğunun ana nedenleriydi. 27 hastaya paklitaksel salınımlı balon anjiyoplasti uygulandı. Girişimlerin klinik başarı oranı %93.1 idi. İki hastada femoral arter ponksiyon yerinde lokal hematom gelişmesi dışında diğer hastalarda başka bir majör veya minör komplikasyon gözlenmedi. Femoral arter yoluyla yapılan PTA girişimleri AVF disfonksiyonlarında etkili ve güvenli bir tedavi yöntemidir.

Anahtar Kelimeler

• Arteriovenöz fistül disfonksiyonu
• Perkütan translüminal anjiyoplasti
• Femoral arter

Proje Numarası

NA

Femoral artery: An Alternative Cannulation Localization in the Angiographic Treatment of Dysfunctional Arteriovenous Fistulas. Single Center Experience

Öz

Although endovascular interventions are the most commonly used treatment modalities in the treatment of dysfunctional AVFs, there is no consensus on the optimal puncture site. In this retrospective single-center study, we present the short-term clinical success rates and complications of our interventions for dysfunctional AVFs via the femoral artery. 29 hemodialysis patients who were diagnosed with AVF dysfunction between January 2016 and December 2019 and therefore underwent percutaneous transluminal angioplasty (PTA) were included in this study. All PTAs were performed by the same experienced interventional cardiologist. Demographic, clinical data of the patients, and data on primary patency and procedural complications used were obtained from the hospital database and electronic records of the patient's own hemodialysis center. Detection of "thrill" after the procedure, successful cannulation, and adequate hemodialysis immediately after the treatment was considered a clinical success. A total of 29 hemodialysis patients underwent PTA due to AVF dysfunction. The median age of the patients was 61 (IQR 55.0-68.0) and 72.4% were male. 41% of patients were diabetic. The Median AVF age was 44.0 (24.0-92.0) months. Juxtaanastomotic (48.3%) and efferent venous stenosis (37.9%) were the main causes of AVF dysfunction. Paclitaxel-released balloon angioplasty was performed on 27 patients. The clinical success rate of the procedure was 93.1%. Two patients developed a local hematoma at the femoral artery puncture site; no other major or minor complications were detected. PTA via the femoral artery is an effective and safe treatment modality for AVF dysfunctions.

Anahtar Kelimeler

• Arteriovenous fistula dysfunction
• Percutaneous transluminal angioplasty
• Femoral artery

Destekleyen Kurum

NA

Proje Numarası

NA

Kaynakça

1. Jager KJ, Kovesdy C, Langham R, Rosenberg M, Jha V, Zoccali C. A single number for advocacy and communication—worldwide more than 850 million individuals have kidney diseases. Oxford University Press; 2019. p. 1803-05.
2. Lok CE, Huber TS, Lee T, Shenoy S, Yevzlin AS, Abreo K, et al. KDOQI clinical practice guideline for vascular access: 2019 update. Am J Kidney Dis. 2020;75(4):S1-S164.
3. Lookstein RA, Haruguchi H, Ouriel K, Weinberg I, Lei L, Cihlar S, et al. Drug-coated balloons for dysfunctional dialysis arteriovenous fistulas. N Engl J Med. 2020;383(8):733-42.
4. Asif A, Gadalean FN, Merrill D, Cherla G, Cipleu CD, Epstein DL, et al. Inflow stenosis in arteriovenous fistulas and grafts: a multicenter, prospective study. Kidney Int. 2005;67(5):1986-92.
5. Malka KT, Flahive J, Csizinscky A, Aiello F, Simons JP, Schanzer A, et al. Results of repeated percutaneous interventions on failing arteriovenous fistulas and grafts and factors affecting outcomes J Vasc Surg. 2016;63(3):772-77.
6. Caplice NM, Wang S, Tracz M, Croatt AJ, Grande JP, Katusic ZS, et al. Neoangiogenesis and the presence of progenitor cells in the venous limb of an arteriovenous fistula in the rat. Am J Physiol Renal Physiol. 2007;293(2):F470-F75.
7. Mezzano D, Pais EO, Aranda E, Panes O, Downey P, Ortiz M, et al. Inflammation, not hyperhomocysteinemia, is related to oxidative stress and hemostatic and endothelial dysfunction in uremia. Kidney Int. 2001;60(5):1844-50.
8. Asif A, Lenz O, Merrill D, Cherla G, Cipleu C, Ellis R, et al. Percutaneous management of perianastomotic stenosis in arteriovenous fistulae: results of a prospective study. Kidney Int. 2006;69(10):1904-09.

9. Croatt AJ, Grande JP, Hernandez MC, Ackerman AW, Katusic ZS, Nath KA. Characterization of a model of an arteriovenous fistula in the rat: the effect of L-NAME. Am J Pathol. 2010;176(5):2530-41.
10. Hammes M. Hemodynamic and biologic determinates of arteriovenous fistula outcomes in renal failure patients. Biomed Res Int. 2015;2015.
11. Çildağ MB, Köseoğlu ÖFK, Akdam H, Yeniçerioğlu Y. The primary patency of drug-eluting balloon versus conventional balloon angioplasty in hemodialysis patients with arteriovenous fistula stenoses. Jpn J Radiol. 2016;34(10):700-04.
12. Lee T, Roy-Chaudhury P. Advances and new frontiers in the pathophysiology of venous neointimal hyperplasia and dialysis access stenosis. Adv Chronic Kidney Dis. 2009;16(5):329-38.
13. Bittl JA. Catheter interventions for hemodialysis fistulas and grafts. JACC Cardiovasc Interv. 2010;3(1):1-11.
14. Diskin CJ. Novel insights into the pathobiology of the vascular access–do they translate into improved care? Blood Purif. 2010;29(2):216-29.
15. Bolton CH, Downs LG, Victory JG, Dwight JF, Tomson CR, Mackness MI, et al. Endothelial dysfunction in chronic renal failure: roles of lipoprotein oxidation and pro‐inflammatory cytokines. Nephrol Dial Transplant. 2001;16(6):1189-97.
16. Himmelfarb J, Stenvinkel P, Ikizler TA, Hakim RM. The elephant in uremia: oxidant stress as a unifying concept of cardiovascular disease in uremia. Kidney Int. 2002;62(5):1524-38.
17. Ghiadoni L, Cupisti A, Huang Y, Mattei P, Cardinal H, Favilla S, et al. Endothelial dysfunction and oxidative stress in chronic renal failure. J Nephrol. 2004;17(4):512-19.
18. Kohler TR, Toleikis PM, Gravett DM, Avelar RL. Inhibition of neointimal hyperplasia in a sheep model of dialysis access failure with the bioabsorbable Vascular Wrap paclitaxel-eluting mesh. J Vasc Surg. 2007;45(5):1029-38. e3.
19. Katsanos K, Karnabatidis D, Kitrou P, Spiliopoulos S, Christeas N, Siablis D. Paclitaxel-coated balloon angioplasty vs. plain balloon dilation for the treatment of failing dialysis access: 6-month interim results from a prospective randomized controlled trial. J Endovasc Ther. 2012;19(2):263-72.
20. Duijm LE, Liem YS, van der Rijt RH, Nobrega FJ, van den Bosch HC, Douwes-Draaijer P, et al. Inflow stenoses in dysfunctional hemodialysis access fistulae and grafts. Am J Kidney Dis. 2006;48(1):98-105.