Raymond Hakim
Last active: 6/9/2014

Access survival amongst hemodialysis patients referred for preventive angiography and percutaneous transluminal angioplasty.

Chan KE, Pflederer TA, Steele DJ, Lilly MP, Ikizler TA, Maddux FW, Hakim RM
Clin J Am Soc Nephrol. 2011 6 (11): 2669-80

PMID: 21959600 · PMCID: PMC3359572 · DOI:10.2215/CJN.02860311

BACKGROUND AND OBJECTIVES - Referring hemodialysis patients for elective access angiography and percutaneous transluminal angioplasty (PTA) is commonly done to prevent access failure, yet the effectiveness of this procedure remains unclear. DESIGN, SETTING, PARTICIPANTS, & MEASURES: An observational matched cohort analysis among 40,132 Medicare beneficiaries receiving hemodialysis with a fistula or graft was performed. Cox regression was used to determine whether access intervention was associated with improved 1-year access survival.

RESULTS - Nonsurgical access intervention was found to be frequent at a rate of 20.9 procedures per 100 access years. In the 1-year period after intervention using angiography and PTA, the overall access failure rate was 53.7 per 100 access years in the intervention group and 49.6 in the nonintervention group (HR = 1.02; 95% CI, 0.96 to 1.08). Similar findings were also seen when the analysis was repeated in only fistulas (HR = 1.06; 95% CI, 0.98 to 1.15) and grafts (HR = 0.95; 95% CI, 0.86 to 1.05). In patients with a low intra-access flow rate (HR = 0.86; 95% CI, 0.75 to 0.99) or a new access (HR = 0.79; 95% CI, 0.71 to 0.89), angiography and PTA significantly increased access survival when compared with nonintervention (P for interaction was <0.0001). Angiography-PTA-related upper-extremity hematoma, vessel injury, or embolism-thrombosis occurred in 1.1% of all patients.

CONCLUSIONS - Access characteristics significantly modify the survival benefits of angiography and PTA intervention where the benefits of these interventions are most seen in newer accesses or accesses with insufficient flow.

MeSH Terms (25)

Aged Angioplasty, Balloon Arteriovenous Shunt, Surgical Blood Vessel Prosthesis Implantation Case-Control Studies Chi-Square Distribution Constriction, Pathologic Female Graft Occlusion, Vascular Humans Kidney Failure, Chronic Linear Models Male Medicare Middle Aged Proportional Hazards Models Radiography Regional Blood Flow Renal Dialysis Risk Assessment Risk Factors Time Factors Treatment Outcome United States Vascular Patency

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