Femoral Arter: Disfonksiyonel Arteriovenöz Fistüllerin Anjiyografik Tedavisinde Alternatif Bir Kanülasyon Lokalizasyonu. Tek Merkez Deneyimi

Endovasküler girişimler, disfonksiyonel arteriovenöz fistüllerin (AVF) tedavisinde en sık kullanılan tedavi modaliteleri olsa da optimal ponksiyon yeri konusunda bir fikir birliği yoktur. Bu retrospektif, tek merkezli çalışmada, femoral arter yoluyla disfonksiyonel AVF'lere yönelik endovasküler girişimlerin kısa vadeli klinik başarı oranlarını ve komplikasyonlarını sunuyoruz. Ocak 2016 ile Aralık 2019 arasında AVF disfonksiyonu tanısı alan ve bu nedenle perkütan transluminal anjiyoplasti (PTA) uygulanan toplam 29 hemodiyaliz hastası bu çalışmaya dahil edildi. Tüm PTA'lar aynı deneyimli girişimsel kardiyolog tarafından yapıldı. Hastaların demografik, klinik verileri, birincil açıklık ve işlem komplikasyonlarına ilişkin veriler hastane veri tabanından ve/veya hastanın kendi hemodiyaliz merkezinin elektronik kayıtlarından elde edildi. İşlem sonrası “thrill”in saptanması, başarılı kanülasyon ve tedaviden hemen sonra yeterli hemodiyaliz yapılabilmesi klinik başarı olarak kabul edildi. Toplam 29 hemodiyaliz hastasına AVF disfonksiyonu nedeniyle PTA uygulandı. Hastaların ortanca yaşı 61 (IQR 55.0-68.0) olup, %72.4'ü erkekti. Hastaların %41'i diyabetikti. Ortanca AVF yaşı 44.0 (24.0-92.0) aydı. Jukstaanastomotik (%48.3) ve efferent ven darlığı (%37.9) AVF işlev bozukluğunun ana nedenleriydi. 27 hastaya paklitaksel salınımlı balon anjiyoplasti uygulandı. Girişimlerin klinik başarı oranı %93.1 idi. İki hastada femoral arter ponksiyon yerinde lokal hematom gelişmesi dışında diğer hastalarda başka bir majör veya minör komplikasyon gözlenmedi. Femoral arter yoluyla yapılan PTA girişimleri AVF disfonksiyonlarında etkili ve güvenli bir tedavi yöntemidir.

Anahtar Kelimeler:

Arteriovenöz fistül disfonksiyonu, Perkütan translüminal anjiyoplasti, Femoral arter

Femoral artery: An Alternative Cannulation Localization in the Angiographic Treatment of Dysfunctional Arteriovenous Fistulas. Single Center Experience

Although endovascular interventions are the most commonly used treatment modalities in the treatment of dysfunctional AVFs, there is no consensus on the optimal puncture site. In this retrospective single-center study, we present the short-term clinical success rates and complications of our interventions for dysfunctional AVFs via the femoral artery. 29 hemodialysis patients who were diagnosed with AVF dysfunction between January 2016 and December 2019 and therefore underwent percutaneous transluminal angioplasty (PTA) were included in this study. All PTAs were performed by the same experienced interventional cardiologist. Demographic, clinical data of the patients, and data on primary patency and procedural complications used were obtained from the hospital database and electronic records of the patient's own hemodialysis center. Detection of "thrill" after the procedure, successful cannulation, and adequate hemodialysis immediately after the treatment was considered a clinical success. A total of 29 hemodialysis patients underwent PTA due to AVF dysfunction. The median age of the patients was 61 (IQR 55.0-68.0) and 72.4% were male. 41% of patients were diabetic. The Median AVF age was 44.0 (24.0-92.0) months. Juxtaanastomotic (48.3%) and efferent venous stenosis (37.9%) were the main causes of AVF dysfunction. Paclitaxel-released balloon angioplasty was performed on 27 patients. The clinical success rate of the procedure was 93.1%. Two patients developed a local hematoma at the femoral artery puncture site; no other major or minor complications were detected. PTA via the femoral artery is an effective and safe treatment modality for AVF dysfunctions.

Keywords:

Arteriovenous fistula dysfunction, Percutaneous transluminal angioplasty, Femoral artery,

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