The Journal of Vascular Access | 2019
Pull-through technique combined with percutaneous angioplasty for treating high-grade arteriovenous fistula stenosis
Abstract
Purpose: The aim of this study was to investigate the effectiveness of a new pull-through technique through a brachial artery approach combined with angioplasty for the treatment of arteriovenous fistula. Methods: In this retrospective study, a total of 56 arteriovenous fistula patients with high-grade stenosis induced by arteriovenous fistula, which was divided into pull-through technique through a brachial artery approach (pull-through group, n\u2009=\u200928) and solely through a venous approach (control group, n\u2009=\u200928), were analyzed. Both groups underwent percutaneous transluminal angioplasty treatments simultaneously. Results: The success rate of the pull-through group (89.3%, 25 out of 28) was similar to that of the control group (75.0%, 21 out of 28, p\u2009=\u20090.296). Fistula restenosis occurred with time in both groups but no significant differences in the post-operative fistula patency were found between the pull-through and control groups in follow-ups at 3, 6, and 12\u2009months (71.4% vs 67.9%, 57.1% vs 60.7%, and 20.0% vs 30.0%, respectively, p\u2009>\u20090.05). No significant difference in the post-operative patency rate in patients with diabetes, hypertension, or coronary disease was found between the pull-through and control groups in the follow-ups at 3 and 12\u2009months, respectively. The pull-through group had significantly shorter operation times compared with the control group (45\u2009±\u20099\u2009min vs 65\u2009±\u200915\u2009min, p\u2009<\u20090.001). No surgical complications were reported in the pull-through group in contrast to three cases (11%, 3 out of 28) with puncture hematoma and acute occlusion in the control group. Conclusion: The pull-through technique combined with percutaneous transluminal angioplasty is an effective, safe and lasting option to treat high-grade arteriovenous fistula stenosis in the upper limb.