Evaluation of Percutaneous Transluminal Angioplasty on the Success of Venoplasty in the Management of Hemodialysis Fistula Stenosis

Abstract

Introduction: Patients with chronic kidney failure whose life depends on routine hemodialysis, need good hemodialysis access. Arteriovenous fistula (AVF) is the best access, but this access is prone to stenosis. The best treatment for the problem of AVF stenosis is by percutaneous transluminal angioplasty (venography /venoplasty). This action has developed in Cipto Mangunkusmo National Hospital since 2013, but there is no data and evaluation of its success. This study was conducted to evaluate the success of venoplasty in the treatment of AVF stenosis. Method: This study used a retrospective cohort study to assess the outcome of percutaneous transluminal angioplasty (venography and venoplasty) actions in AVF stenosis in patients with chronic kidney failure. The study was conducted in the Ward Division of Vascular and Endovascular Surgery, Integrated Heart Center, Cipto Mangunkusumo National Hospital’s medical records installation, and Hermina Depok Hospital from December 2016 to May 2017 by evaluating the demographic characteristics, underlying diseases, venoplasty, and venography assessment results, and ultrasound results. Results: Characteristics of people with chronic kidney disease with AVF stenosis were found mostly in the age group 50-60 years (40.9%). As many as 59% of patients were male, and underlying disease was mainly caused by hypertension (93.9%) and diabetes mellitus (42.4%). We found a significant relationship between age and sex with the size of AVF stenosis from demographic analysis. There was no significant relationship between the underlying disease, the location of AVF stenosis, and the venography’s outcome with the size of AVF stenosis from venography. There was a significant relationship between the location of AVF stenosis and the success of venoplasty. There was a significant increase in the results of the ultrasound examination, which were the draining vein diameter, volume flow, and peak systolic velocity to the results of venoplasty after the procedure or three months after the procedure. Conclusion: There was a significant relationship between age and sex with the size of AVF stenosis that occurred. There was no significant relationship between the underlying disease, the location of AVF stenosis with the size of AVF stenosis from venography. A significant relationship was found between the location of AVF stenosis and the success of venoplasty. There was a significant relationship between the results of the ultrasound examination (diameter draining vein, volume flow, and peak systolic velocity) to the results of venoplasty after the procedure or three months after the procedure. Keywords: arteriovenous fistula stenosis, percutaneous transluminal angioplasty, venoplasty, ultrasound