Duplex ultrasound-guided angioplasty of hemodialysis vascular access

ObjectiveDuplex-guided angioplasty (DA) for hemodialysis vascular accesses remains questionnable regarding its feasability and safety. Minor complications (requiring no more treatment than nominal therapy) might be overreported. Our hypothesis is that this procedure has no significant differences between observed rates and the recommended threshold of main outcomes of the procedure defined by the standards of arteriovenous fistulas (AVF) angioplasty.MethodsIn a single-center retrospective study, 298 DA performed on 141 patients from 2015 to 2019 were analyzed. Occluded AVF or concomittant use of X-ray were excluded. Duplex ultrasound parameters were collected up to 1 month before, at the end of angioplasty and on day 30 post-procedure. Complications were registered, and patency rates were studied at 24 months of follow-up.ResultsAnatomical success was achieved in 142 (47.7%) procedures, clinical success in 284 (95.3%) of them and hemodynamic success in 283 (95.0%). Major complications - requiring at least a specific therapy - were reported in 8 (2.7%) procedures and minor complications - requiring no adjunctive therapy - in 157 (52.7%). At 24 months, overall postintervention primary patency (PP) was 34.0%, primary assited patency (PAP) 87.4% and secondary patency (SP) 92.5%. There were no significant differences of patency rates between groups with or without minor complications (p value for PP: 0.08, PAP : 0.08, SP : 0.23) or 30% residual stenosis (p value for PP: 0.82, PAP : 0.46, SP : 0.63). Duplex parameters further improved at D30 post-angioplasty.ConclusionDA of AVF is feasible, safe - despite overreported minor complications having no impact on postintervention patency rates - and efficient. A minor complication can be seen as an event without consequence of neither bad or good prognose. Anatomical definition of success does not fit on DA for haemodialysis vascular access. Further studies are required to define duplex parameters threshold for efficacy.