3:10 PM Abstract No. 232 Factors associated with the secondary functional access patency after percutaneous transluminal angioplasty of the early failing or immature hemodialysis arteriovenous fistula

To evaluate the efficacy of percutaneous transluminal angioplasty (PTA) for early failing hemodialysis arteriovenous fistula (AVF) and predictive factors for the secondary functional patency. A review of the endovascular registry database for our department showed 61 patients with the early failure after the surgically created AVF underwent endovascular intervention between July 2011 and October 2016. The patients were characterized by being 48% male with median age of 68 years. The median of the duration of time from AVF creation to first intervention was 5.6 weeks (range, 1-12 weeks). Median duration of follow-up was 14 months. Items concerning technical success rate, primary and secondary functional patency, factors associated with secondary functional patency were analyzed. Angiography revealed 38 stenoses and 23 occlusions. Median length of lesions was 4.5 cm (range; 1-25 cm). Technical success was achieved in 55 (90%) of 61 patients. The primary and secondary functional patency rates were 42% and 65% at 12 months, respectively. Univariate analysis indicated that lesion length (p = 0.009) and lesions including juxta-AVF (p = 0.057) should be considered as a risk factor for secondary functional patency. Multivariate analysis using Cox proportional hazards regression model indicated lesion length (hazard ratio; 1.15, P = 0.001) and lesion including juxta-AVF (hazard ratio; 6.30, P = 0.008) as a risk factor associated with secondary functional patency. ROC curve analysis indicated lesion length ≥9 cm as a cutoff value of a risk factor for secondary functional patency. The secondary functional patency at 12 months was 86% for patients with no risk factor (n = 23), 65% for patients with 1 risk factor (n = 33), and 0% for patients with 2 risk factors (n = 5). There was significant difference in secondary functional patency rate among these groups (P = 0.001). The juxta-AVF lesion and length of lesions are the risk factors for the secondary functional patency. Secondary functional patency rate at 12 months is acceptable in patients without risk factors.