Aggressive treatment of early fistula failure

摘要: Aggressive treatment of early fistula failure. Background Fistula failure has been classified as and late. Early refers to those cases in which the arteriovenous (AV) never develops point that it can be used or fails within first 3 months usage. It common practice abandon these failures; however, aggressive evaluation failures shown result salvage a large percentage. The two most causes seen at this time are juxta-anastomotic stenosis (JAS) presence accessory veins. Both easily diagnosed by physical examination. This study reports results managed aggressively an attempt salvage. Methods These studies were conducted six freestanding outpatient interventional facilities different regions United States. Interventional nephrologists employed all except one is operated radiologist. Each patient was evaluated angiographically identify anatomy their AV detect abnormalities might present. Stenotic lesions then treated with angioplasty veins thought significant obliterated. All patients followed determine if usable for dialysis. Results One hundred identified met definition Venous present 78% cases. In 43% cases, lesion JAS location. 15%, only 24%, associated vein, 6% proximal stenosis, 4% both. A 36%. 6%, JAS, arterial anastomosis 38% always association JAS. four stenotic artery above anastomosis. An vein 46% 12% 24% anomaly Angioplasty performed treat venous 72% 98% success rate. 38 100% Accessory obliteration overall complication rate series 4%, 3% minor 1% major. possible initiate dialysis using 92% Actuarial life-table analysis showed 84% functional months, 6 68% 12 months. Conclusion If correctable pathology detected failure, incidence relatively high therapeutic approach expected have yield.