Coil Embolization As An Adjunct In Fistula Maturation
Daniel P. Berkowitz, BS, Scott A. Sundick, MD, Raymond J. Holmes, MD, Clifford M. Sales, MD.
The Cardiovascular Care Group, Springfield, NJ, USA.
Objective: Side branch occlusion is a helpful adjunct in arteriovenous fistula maturation. Its efficacy in treating non-maturation and impaired flow in the hemodialysis access circuit has been poorly characterized. We sought to evaluate and report our recent experience regarding his endovascular procedure.
Methods: 44 patients were treated with coil embolization for non-maturation or inadequate flow in their arteriovenous fistula over the past one year. Outcome of the procedure was evaluated at the dialysis unit. We utilized a simple metric: was the fistula able to be cannulated with adequate flows for hemodialysis to be accomplished following the side branch coil occlusion. The type of the fistula and the details of the procedure were reviewed.
Results:17 (39%) patients had a radiocephalic configuration, 25 (57%) brachiocephalic, and 2 (4%) had percutaneous AVFs. 25 (57%) patients had an angioplasty included in their initial endovascular treatment. 13 (32%) patients needed embolization less than 12 weeks after AVF creation, 5 (42%) of which were able to cannulated without further intervention. Of the 27 (67%) interventions after 12 weeks of AVF creation, 11 (41%) were able to be cannulated without future treatment. The mean time from AVF creation to coil embolization was 24 weeks. 35 (80%) patients had 1 branch treated and 8 (20%) patients multiple branches embolized. From the total sample, 17 (39%) did not require further intervention as they were able to be cannulated and successfully dialyzed. 19 (43%) patients needed follow-up procedures after the coil embolization. These procedures included angioplasty (77%), thrombectomy (10%), repeat coil embolization (37%), and creation of a new AVF (10%). Eight (18%) patients were lost to follow-up.
Conclusion: Coil embolization of patent side branches can be effective in assisting fistula maturation. However, it often requires further adjunctive procedures to attain its goal of creating a functional fistula. Aggressive management of the non-maturing fistula is warranted and likely will require combined procedures in conjunction with coil embolization.
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