Duplex ultrasound-guided angioplasty of hemodialysis vascular access

Fabrice Abbadie; George Kosmadakis; Didier Aguilera; Aurélien Piraud

doi:10.1016/j.jvs.2023.07.007

Duplex ultrasound-guided angioplasty of hemodialysis vascular access

J Vasc Surg. 2023 Nov;78(5):1292-1301.e3. doi: 10.1016/j.jvs.2023.07.007. Epub 2023 Jul 16.

Authors

Fabrice Abbadie¹, George Kosmadakis², Didier Aguilera³, Aurélien Piraud⁴

Affiliations

¹ Vascular Medicine Unit, Vichy District Hospital, Vichy, France. Electronic address: fabrice.abbadie@gmail.com.
² AURA Santé, Clermont-Ferrand, France.
³ Department of Nephrology, Vichy District Hospital, Vichy, France.
⁴ Department of Clinical Research, Vichy District Hospital, Vichy, France.

PMID: 37463647
DOI: 10.1016/j.jvs.2023.07.007

Abstract

Objective: Duplex ultrasound-guided angioplasty (DA) for hemodialysis vascular accesses remains questionable regarding its feasibility and safety. Minor complications (requiring no more treatment than nominal therapy) might be over-reported. Our hypothesis is that this procedure has no significant differences between observed rates and the recommended threshold of main outcomes of the procedure defined by the standards of arteriovenous fistulas (AVF) angioplasty.

Methods: In a single-center retrospective study, 298 DA performed on 141 patients from 2015 to 2019 were analyzed. Occluded AVF or concomitant use of radiographic guidance were excluded. Duplex ultrasound parameters were collected up to 1 month before, at the end of angioplasty, and on day 30 after the procedure. Complications were registered, and patency rates were studied at 24 months of follow-up.

Results: Anatomical success was achieved in 142 procedures (47.7%), clinical success in 284 (95.3%), and hemodynamic success in 283 (95.0%). Major complications-requiring at least a specific therapy-were reported in 8 procedures (2.7%) and minor complications-requiring no adjunctive therapy-in 157 (52.7%). At 24 months, overall postintervention primary patency was 34.0%, primary-assisted patency 87.4%, and secondary patency 92.5%. There were no significant differences of patency rates between groups with or without minor complications (P value for primary patency, 0.08; primary-assisted patency, 0.08; secondary patency, 0.23) or 30% residual stenosis (P value for primary patency, 0.82; primary-assisted patency, 0.46; secondary patency: 0.63). Duplex parameters further improved at postoperative day 30 after angioplasty.

Conclusions: DA of AVF is feasible, safe-despite over-reported minor complications having no impact on postintervention patency rates-and efficient. A minor complication can be seen as an event without bad or good consequences. Anatomical definition of success does not fit on DA for hemodialysis vascular access. Further studies are required to define the duplex parameter threshold for efficacy.

Keywords: Arteriovenous fistulas; Ultrasound-guided angioplasty.