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ORIGINAL ARTICLE
Year : 2018  |  Volume : 37  |  Issue : 4  |  Page : 588-594

Evaluation of duplex guided balloon angioplasty for salvage of failing hemodialysis access


Department of Surgery, Vascular and Endovascular Unit, Suez Canal University Hospital, Ismailia, Egypt

Correspondence Address:
Ahmed M Abd El Rahim Hamed
Resident of Vascular Surgery, Faculty of Medicine, Suez Canal University Hospital, Ismailia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejs.ejs_102_18

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Background Duplex ultrasonography plays a vital role in imaging of endovascular procedures of dialysis fistulas. Endovascular procedures coupled with ultrasonography gives a simple and reliable visualization of vessels forming fistula, avoiding the hazards associated with radiological imaging and lowers the financial burden. Trials have started depending on the ultrasonography imaging for intravascular interventions. Adding duplex to these procedures facilitate the accurate sizing of balloons and stents and enables us to objectivThe results ofintervention showed success rate in 18 (90%) patients evidenced by improvedpalpable thrill, residual stenosis less than 30%, restoring the function of AVF inhemodialysis. Local complications were treated conservatively, such as hematomain four (20%) cases and local inflammatory signs in two (10%) cases. None of thepatients lost his access due to intervention, two (10%) cases failed despiteintervention; one case due to thrombosis, a trial of thrombectomy by fogertycatheter was done. The other case failed to mature and maintained smallcaliber. Follow up was done for all cases for at least 3 months to confirmrestoring function of the hemodialysis accesses.ely and quantitatively assess the need and the results of intervention. Aim Evaluation of the effectiveness of duplex-guided balloon angioplasty for salvage of failing hemodialysis accesses and maintain their function. Patients and methods Twenty patients presented to the vascular surgery unit, in Suez Canal University Hospital between February 2017 and February 2018, eight (40%) presented with failing to mature arteriovenous fistulas (AVF) postcreation by more than 4 weeks,12 (60%) presented with failing AVF after usage in hemodialysis,6F sheath was used, 5-6 mm balloons were appropriate for most of the cases, arterial and venous approaches were used. Results The results of intervention showed success rate in 18 (90%) patients evidenced by improved palpable thrill, residual stenosis less than 30%, restoring the function of AVF in hemodialysis. Local complications were treated conservatively, such as hematomain four (20%) cases and local inflammatory signs in two (10%) cases. None of thepatients lost his access due to intervention, two (10%) cases failed despite intervention; one case due to thrombosis, a trial of thrombectomy by fogerty catheter was done. The other case failed to mature and maintained small caliber. Follow up was done for all cases for at least 3 months to confirm restoring function of the hemodialysis accesses. Conclusion Duplex-guided balloon angioplasty of nonmaturing and failing AVF is a safe and effective procedure. It is associated with high success rates, low complication rates, and maintained long-term patency of the hemodialysis access.


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