Duplex Guided Dialysis Access Interventions can be Performed Safely in the Office Setting: Techniques and Early Results

Abstract Objective To determine the utility of duplex guided angioplasty for hemodialysis access maturation and maintenance. Design/Materials/Methods Between January 2008 and June 2009, 223 office-based duplex-guided hemodialysis access angioplasty procedures were performed in 125 patients. Two hund...

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Bibliographic Details
Published in:European journal of vascular and endovascular surgery 2011-12, Vol.42 (6), p.833-841
Main Authors: Fox, D, Amador, F, Clarke, D, Velez, M, Cruz, J, Labropoulos, N, Ryan, M, Gelman, L
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Angioplasty
Angioplasty - methods
Arm - blood supply
Arteriovenous Shunt, Surgical
Blood Flow Velocity - physiology
Dialysis
Doppler
Duplex
Female
Humans
Male
Middle Aged
Postoperative Complications - etiology
Renal Dialysis
Surgery
Ultrasonography
Ultrasonography, Doppler, Duplex - methods
Ultrasonography, Interventional - methods
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Summary:Abstract Objective To determine the utility of duplex guided angioplasty for hemodialysis access maturation and maintenance. Design/Materials/Methods Between January 2008 and June 2009, 223 office-based duplex-guided hemodialysis access angioplasty procedures were performed in 125 patients. Two hundred eight of the accesses were autogenous. The most common indication for intervention was maturation failure (104 cases). Other indications included pulsatility, low access flow, decreased flow and infiltration. Procedures were performed in the office using topical and local anesthesia. Volume flow (VF) was recorded prior to introducer insertion (baseline) and post intervention. Results Technical success was achieved in 219 cases (98.2%). Minor complications occurred in 21 cases (9.4%). Immature autogenous AV accesses had a median baseline VF of 210 mL/min. Median final VF for these autogenous AV accesses was 485 mL/min. The VF increased by 131%. Dysfunctional autogenous AV accesses and nonautogenous AV accesses had a median baseline VF of 472 mL/min. Median final VF was 950 mL/min. The VF increased by 101%. Conclusions Duplex guided dialysis access angioplasty can be performed safely and effectively in the office setting. It offers the advantage of treating the patient without radiation or contrast as well as the assessment of the hemodynamic effects of intervention.
ISSN:1078-5884
1532-2165
DOI:10.1016/j.ejvs.2011.04.020