Predicting Factors for Successful Maturation of Autogenous Haemodialysis Fistulas After Salvage Percutaneous Transluminal Angioplasty in Diabetic Nephropathy: A Study on Follow-Up Doppler Ultrasonography

Abstract

Background: Maturation failure of autogenous arteriovenous fistula (aAVF) has been increasing after surgical procedures and the salvage percutaneous transluminal angioplasty (sPTA) for immature aAVF has been identified as an effective treatment modality Objectives: The aim of this study was to identify factors predicting successful aAVF maturation and to determine positive technical aspects of sPTA. Patients and Methods: We retrospectively reviewed medical records and radiological images of 59 patients who had undergone sPTA for non-maturing aAVFs. We analysed images from pre-surgical mapping Doppler ultrasonography angiography, and angioplasty and follow-up Doppler ultrasonography performed within two weeks after sPTA. We assessed the following factors, for their ability to predict successful aAVF maturation:1) patient factors (age; sex; co-morbidities; and aAVFage, side and type); 2) vessel factors (cephalic vein diameter and depth, presence of accessory veins, and pre -and postoperative radial artery disease); 3) lesion factors (stenosis number, location and severity); and 4) technical factors (presence of residual stenos is and anatomic success ratio (ASR) on follow-up Doppler ultrasonography). Results: The technical and clinical success rates were both 94.9% (56159); the meanASRwas 0.84.AnASRof >.o.7and no significant residual stenos is (<30%) (both P< 0.001 at) on two-week follow-up Doppler ultrasonography predicted successful aAVF maturation. Conclusion: For more precise prediction of successful aAVF maturation after sPTA, short-term follow-up Doppler ultrasonography (< 2 weeks) was useful. If the ASR was <0.7 or if residual stenosis was > 30%, immediate repeat sITIA is recommended.