2000 Volume 11 Issue 1 Pages 29-33
The role of percutaneous treatment in the management of venous stenosis in hemodialysis patients with arteriovenous access graft in the lower extremity is unclear. The purpose of the study to evaluate the efficacy of percutaneous treatment of venous stenosis in patients with lower extremity bridge fistulas was retrospectively analysis. Twenty percutaneous treatment of venous stenosis were performed in 11 patients (2 men and 9 women, 47～75 years of age; mean, 60.3±8.2 years) with hemodialysis fistula in the lower extremity. The lesion was located on the saphenous vein in 2, the femoral vein in 4, the femoral and external iliac vein in 1, the external iliac vein in 4, and the common iliac vein in 3 cases. Palmaz stent implantation became necessary in 6 of 20 (30%), because the indication for stent placement restricted to insufficient restoration after simple balloon dilatation and early restenosis within the one year. Extremity swelling was improved and reduction of the pressure gradient was achieved in all cases. No acute complication, excluding one venous rupture during balloon inflation with 10 atmospheres occured during and after procedures. The venous rupture was treated with sustained balloon inflation and temporary graft clamp. The primary patency rates for percutaneous treatment including stent placement at 3, 6, 12, 15 months were 86.7%, 85.7%, 71.4% and 66.7%, respectively. None of angiographic restenoses in the stent placement sites were observed. Four patients died during the follow-up period, however these deaths were not directly related to these procedures. In 10 patients (90.9%) the shunt was still used for hemodialysis until the end of the observation period or the patient’s death. Although the number of patients may be too small and the follow-up period may be too short to make a valid conclusion regarding the efficacy of percutaneous treatment of venous stenosis in patients with lower extremity bridge fistulas, our results suggest that percutaneous treatment including stent placement is safe and effective in preserving functioning dialysis access fistula in the lower extremity.
