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Long Term Outcomes of Patch Angioplasty Maturation for Arteriovenous Fistulas
Michael H. Parker, MD, Homayoun Hashemi, MD, Caila Bachmann, BA BS, Lolita Ramsey, PhD, Dipankar Mukherjee, MD, Richard F. Neville, MD.
Inova Fairfax Medical Campus, Falls Church, VA, USA.

OBJECTIVES:Autogenous arteriovenous fistulas (AVFs) have a primary failure rate of 20-60%. Patch Angioplasty Maturation (PAM) is a novel technique to assist in the maturation of AVFs. PAM has previously been shown to deliver excellent short-term results with 92% of PAM AVFs progressing to function for hemodialysis. The purpose of this study is to assess the long-term outcomes of PAM AVFs.
METHODS: A single-center, retrospective cohort study was performed of adults age 18+ who underwent PAM between January 1, 2007 and December 31, 2019. PAM was performed with bovine pericardial patch (2cm x 9cm or 2.5cm x 15cm) of adequate length to correct AVF stenosis/non-dilation. Outcomes were considered successful if the PAM AVF was functional for the most recent hemodialysis of record with notation of primary patency (no additional procedures) and secondary patency (including additional procedures). The outcomes of interest were primary and secondary patency censured for death and loss to follow-up. Descriptive statistics and Kaplan-Meier estimations determined time of overall patency (censored for death, kidney transplant, peritoneal dialysis and < 12 months follow-up).
RESULTS:
During the study interval, 164 PAM AVFs were performed with 12 failures to mature, and 6 patients excluded due to death or loss of follow-up. Demographics of the cohort with successful maturation (N=146) included: mean age 67 years (12.9 SD), 56% male, 39% White Non-Hispanic, 94% hypertensive, 66% diabetic. PAM AVF configurations included both radiocephalic (33% proximal radial, 26% distal radial) and brachiobasilic (27%). The mean patency for the cohort was 120 months. Primary patency was as follows: 1 year 64% (70/109), 2 years 54% (44/82), 3 years 46% (27/59), 4 years 39% (14/37) and 5 years 35% (10/25). Secondary patency was as follows: 1 year 95% (104/109), 2 years 88% (72/82), 3 years 83% (49/59), 4 years 75% (28/37) and 5 years 73% (18/25).
CONCLUSIONS:
PAM is an effective procedure to salvage AVFs that fail to mature adequately for hemodialysis. This analysis examined the long-term function of the PAM AVF construction and found very acceptable primary and secondary patency to maintain dialysis access in patients with otherwise failing AVFs. The PAM technique should be considered for those AVFs that fail to mature prior to abandoning them for another access.


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