Clinical Course of Hemodialysis Access after Initial Endovascular Intervention for Stenosis in Asian Renal Failure Patients

Abstract

Background: Arteriovenous fistula (AVF) and arteriovenous fistula graft (AVG) access for hemodialysis can develop stenosis, eventually leading to thrombosis and access failure. Prompt endovascular intervention can salvage the access but restenosis does occur. Clinical course, restenosis pattern, and risk factors associated with initial stenosis of AVFs/AVGs in Asian hemodialysis patients were studied. Method: A retrospective study was conducted (January 2009-June 2012) on consecutive patients with renal failure who developed the first-time stenosis in the vascular access and were managed with endovascular intervention. One hundred fourteen patients (54 AVFs and 60 AVGs) were studied, and all clinical outcomes were recorded until October 2013. Results: The mean time from access creation to endovascular intervention for the first-time stenosis for patients with AVF and AVG was 23.5 (32.7 standard deviation [SD]) months and 12.5 (11.0) months, respectively. An average of 1.7 (range, 1-5) interventions were performed for AVFs, whereas 2.4 (range, 1-11) for AVGs (P =.008). Upon conclusion of the study, 23 patients with AVF survived with functional index access, whereas 10 passed away with a functional original access. The remaining 21 patients with AVFs failed, requiring new access, tunneled catheter, or peritoneal dialysis. Of the 60 patients with AVG, 6 survived and 8 died with functional index access; 46 required new access or other forms of dialysis (P =.000). Kaplan-Meier estimated that access patency and survival with functional access were significantly lower for AVGs than for AVFs after the first salvage intervention. Female patients had an increased risk of restenosis with both univariate (P =.016) and multivariate (P =.013) analysis. With univariate analysis (P =.039), patients with hyperlipidemia had a higher risk of developing restenosis in the vascular access. Conclusion: The clinical course and prognosis of failing AVFs and AVGs are distinct. The information on access prognosis and stenosis recurrence patterns will be helpful for patient counseling and planning of follow-up intervals, after the first-time intervention for access stenosis.