Outcome of Immediate Interventions in Acute Dysfunctional Hemodialysis Fistulas

Abstract

Purpose: To analyze the efficacy of interventions in acute dysfunctional hemodialysis fistulas, if intervention is performed immediately as recommended by European Best Practice Guidelines for Hemodialysis.

Materials and Methods: Over 3 years, all (n = 280) patients with an acute dysfunctional hemodialysis fistula were immediately referred to angiography, irrespective of the time of day. Angiography and, if possible, interventional revision (n = 241) were performed. Three groups of interest were established: interventionalist’s experience (high/low), time of day (routine hours: 7 am–4 pm/emergency hours: 4 pm–7 am), lesion type (stenosis/fibrosclerotic occlusion/thrombotic occlusion/combined stenosis+thrombotic occlusion). For statistical analysis corresponding success rates, chi-square tests (p < 0.025) and logistic regression analysis (p < 0.05) were calculated.

Results: The total success rate was 62 % (149/241). The success rates were: interventionalist experience high/low 71 % (79/111)/54 % (70/130), p = 0.022; time of day routine/emergency hours 68 % (93/136)/53 % (56/105), p = 0.017; lesion type stenosis/fibrosclerotic occlusion/thrombotic occlusion/combined stenosis+occlusion 82 % (94/104)/39 % (13/33)/18 % (6/33)/59 % (36/61), p < 0.001. Relevant variables due to logistic regression analysis were high experience and the lesion types stenosis and combined stenosis+occlusion with odds ratios 2.300 (p = 0.012), 12.053 (p < 0.001), 3.189 (p = 0.003).

Conclusion: Unrestricted implementation of immediate interventions in acute dysfunctional hemodialysis fistulas requires permanent availability of experienced interventionalists. The lesion types fibrosclerotic occlusion and thrombotic occlusion offer poor success rates for interventional revision.

Zusammenfassung

Ziel: Evaluation der interventionellen Revision akut dysfunktioneller Dialyseshunts bei sofortiger Intervention wie von European Best Practice Guidelines for Hemodialysis empfohlen.

Material und Methoden: Über 3 Jahre wurden alle (n = 280) Patienten mit akut dysfunktionellem Dialyseshunt unabhängig von der Tageszeit zur Angiografie vorgestellt. Eine Angiografie und, falls möglich, interventionelle Revision wurden bei n = 241 Fällen durchgeführt. Es wurden 3 Beobachtungsgruppen gebildet: Erfahrungsgrad des Interventionalisten (hoch/niedrig), Tageszeit (Routinearbeitszeit, 7 – 16 h; Notdienstzeit, 16 – 7 h), Läsionsart (Stenose/fibrosklerotischer Verschluss/thrombotischer Verschluss/kombiniert Stenose+Thrombose). Für die statistische Analyse wurden die korrespondierenden Erfolgsraten, Chi-Quadrat-Tests (p < 0,025) und eine logistische Regressionsanalyse (p < 0,05) berechnet.

Ergebnisse: Die Gesamterfolgsrate betrug 62 % (149/241). Die Erfolgsraten waren nach Interventionalist für hohen/niedrigen Erfahrungsgrad 71 % (79/111)/54 % (70/130), p = 0,022; nach Tageszeit für Routinearbeitszeit/Notdienstzeit 68 % (93/136)/53 % (56/105), p = 0,017; nach Läsionsart für Stenose/fibrosklerotischen Verschluss/thrombotischen Verschluss/kombiniert Stenose+Thrombose 82 % (94/104)/39 % (13/33)/18 % (6/33)/59 % (36/61), p < 0,001. In der logistischen Regressionsanalyse waren relevante Variablen hoher Erfahrungsgrad und die Läsionsarten Stenose und kombiniert Stenose+Thrombose mit einer Odds Ratio von 2,300 (p = 0,012), 12,053 (p < 0,001), 3,189 (p = 0,003).

Schlussfolgerung: Eine uneingeschränkte Umsetzung sofortiger Interventionen bei akut dysfunktionellen Dialyseshunts erfordert die permanente Bereitschaft eines Interventionalisten mit hohem Erfahrungsgrad. Die Läsionsarten fibrosklerotischer und thrombotischer Verschluss bieten nur geringe Erfolgsraten bei interventioneller Revision.

Key words

vascular - interventional procedures - efficacy studies - hemodialysis fistula

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