Radiocephalic fistula yields best post-intervention patency rates
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The radiocephalic fistula yielded the best post-intervention primary patency rates when compared to brachiocephalic fistula and brachiobasilic fistula, according to study results reported in Kidney Medicine.
“There is limited data on ... post-intervention patency in fistulas constructed in non-dialysis dependent patients, and given the high incidence of endovascular procedures on immature fistulas, more investigation is warranted,” Edwin Takahashi, MD, of the Mayo Clinic department of radiology, and colleagues wrote. “The purpose of this study was to determine the predictors of recurrent lesions in fistulas constructed in the nondialysis- dependent population and evaluate the outcomes after endovascular therapy.”
In an observational study of nondialysis-dependent patients with fistulas from 1995 to 2015, researchers identified 210 patients. Of the identified cases, 65.7% of patients had a brachiocephalic fistula, 18.6% of patients had a radiocephalic fistula, 14.3% of patients had a brachiobasilic fistula, 1% of patients had a ulnocephalic fistula and 0.5% of patients had a radiobasilic fistula. Patients underwent diagnostic fistulography and were referred for surgical intervention if the fistula failed percutaneous therapy.
Of the fistulas studied, 9% failed to mature for dialysis. The median post-intervention primary patency, post-intervention primary-assisted patency and secondary patency was reported at 2.7 years in the radiocephalic fistula, 3.2 years in the brachiocephalic fistula and 3.6 years in the brachiobasilic fistula.
Overall rates at 1 year for primary, primary-assisted and secondary patency were reported 53% for radiocephalic fistulas, 87.7% for brachiocephalic fistulas and 83.5% for brachiobasilic fistulas. Thrombosis developed with 21.9% of fistulas and 35.2% were abandoned.
“Among nondialysis-dependent patients who undergo initial endovascular therapy to maintain fistula patency, the radiocephalic configuration was found to have the best post-intervention primary patency compared to other configurations,” Takahashi and colleagues concluded. “While the majority of hemodynamically significant lesions occurred at the anastomosis, lesions in the non-cannulation zone of the outflow vein had the highest rates of target lesion revascularization and may require more aggressive treatment.” – by Kate Burba
Disclosures: The authors reported no relevant financial disclosures.
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https://www.kidneymedicinejournal.org/article/S2590-0595(20)30067-4/fulltext
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