duplex guided...

1. DUPLEX GUIDED ANGIOPLASTY OF VASCULAR ACCESS AND IT’S SHORT TERM PATENCY:
AN INDIAN EXPERIENCE
MAHAJAN R1, JASUJA S2, SAGAR G2.
1. Department of Vascular surgery, 2. Department of Nephrology, Indraprastha Apollo Hospitals, New Delhi, India
Background: As more patients are living longer on dialysis
it becomes important to preserve the venous estate. Failing
access can often be salvaged by endovascular means. As
angioplasty in our scenario is more expensive than surgical
procedures, the endovascular experience in vascular access
is limited. We present our short-term results duplex-
guided procedures.
Methods: In the last 18 months we carried out 24 duplex-
guided angioplasty procedures in 20 patients (12 patients
with AVF and 8 with AVG). Patency was assessed at 3 and
then 6 months. The sole indication for intervention was
failing vascular access with poor flows. Hemodynamically
significant stenosis were identified by the presence of B-
mode diameter reduction, colour bruit and peak systolic
velocity elevation>2. Image guidance was obtained using
GE VIVID-e ultrasound system with an 8MHz probe. The
measure of therapeutic success was primarily duplex
derived flow volumes.
Conclusions: Duplex Guided angioplasty of hemodialysis
vascular access in our set up appears to be a safe procedure
with few complications. It seems to be effective in the short
term but long term patency and its cost implications would
require further evaluation.
Results: 23 (95.8%) interventions had significant
improvement in flow volumes immediately post procedure
and at 3 months of follow up. Only one patient developed a
small hematoma at the introducer site and none other had
any complication. One patient with an AVG required repeat
angioplasty after 5 months but all others had good
significant flow volumes at 6 months. Dialysis adequacy was
confirmed by the dialysis staff monthly till six months. None
of our patient required stenting. The average cost of
balloon angioplasty was around 1500 USD.