Venous rupture during percutaneous treatment of hemodialysis fistulas and grafts
✍ Scribed by John A. Bittl
- Publisher
- John Wiley and Sons
- Year
- 2009
- Tongue
- English
- Weight
- 136 KB
- Volume
- 74
- Category
- Article
- ISSN
- 1522-1946
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✦ Synopsis
Abstract
Objectives: The aim of this study was to analyze the risk and consequences of venous rupture during angioplasty of malfunctioning hemodialysis grafts and fistulas. Background: Venous stenoses in the outflow limb of hemodialysis accesses often require ultra‐high balloon pressure for optimal dilatation. Methods: Baseline characteristics and outcomes were analyzed for a consecutive series of patients treated between 1999 and 2008. Results: Venous rupture or perforation occurred in 11 of 1242 (0.9%) procedures. No patient with a rupture or perforation died or required emergency or urgent surgical repair. Two of 11 patients (18.2%) required transfusions, 8 of 11 patients (72.7%) required stenting, and 6 of 8 (75.0%) who needed stenting received covered stents to achieve hemostasis. Rupture led to access thrombosis within 30 days in 9 of 11 cases (82%). Multivariable logistical regression analysis suggested that using a balloon catheter more than 2 mm larger than the diameter of the hemodialysis access or using peripheral cutting balloons increased the risk of rupture or perforation. Conclusions: Rupture or perforation is a rare complication of treatment of malfunctioning hemodialysis grafts and fistulas. The complication may be managed with nonsurgical methods and might be avoided by optimal balloon selection and sizing. © 2009 Wiley‐Liss, Inc.