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Contribution Of Arterial Inflow Disease In Patients With Failing Ipsilateral Av Access
Mark G. Davies, MD PhD MBA1, Joseph P. Hart
2.
1Ascension Health, Waco, TX, USA,
2MCW, Milwaukee, WI, USA.
Background: Arterial inflow disease can compromise the function of primary AV access in the upper extremity. The aim of this study was to examine the contribution of arterial Inflow disease outcomes of interventions to treat arterial inflow disease in the upper extremity of patients presenting with failing primary vascular access.
Methods: A database of patients presenting with documented failing primary AV Access between 2014 and 2024 was retrospectively queried. Patients with arterial inflow disease who underwent intervention of the inflow vessels were selected.. Patients with occluded AVF were excluded. 30-day outcomes and long-term outcomes of arterial patency and freedom from major adverse limb events (MALE; Above ankle amputation of the index limb or major re-intervention, new bypass graft, jump/interposition graft revision) were evaluated. Functional dialysis (continuous HD for three consecutive months) was also examined.
Results: 334 patients (61% female, 63
+11 years) presented with failing primary AV Access: 55% were brachiocephalic, 23% were brachiobasilic, 12% were radiocephalic, and 5% were AV grafts. 94 (28%) of the patients had evidence of arterial inflow disease in the subclavian, brachial, or radial arteries: 8% of the patients had subclavian disease, 35% had proximal brachial or radial artery occlusive disease, and the remainder (57%) had arterial anastomotic disease. Patients with subclavian disease underwent stent placement; patients with axillary, brachial, and radial artery disease underwent balloon angioplasty. Technical success was 82%. Of the 17 patients that failed, open patch angioplasty or bypass was perfromed. . The major adverse cardiovascular event (MACE) rate was <1%. The 30-day complications included thrombosis (3%), bleeding (1%), and infection (1%). Cumulative 3 year patency of the open and endovascular interventions was 91±7% and 63±6%, respectively. Access functionality was 76±9% at 3 years. The predictors of successful salvage were brachiocephalic access, remote inflow disease, absence of concomitant venous outflow stenoses, and improved flow volumes at 1 month after intervention.
Conclusions:Arterial inflow disease in failing AV access occurs in over a quarter of cases.. Interventions are associated with a high rate of success at the arterial level and sustained AV access functionality
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