D FERNANDES 1, S CHERIAN 1, B PAWAR 1, S THOMAS 1, S NAYAR 1, P GEORGE 1, M BROWN 1, S KODIGIRE S1, M HAMILTON , M MANTHA , S BALAKRISHNAN
1Alice Springs Hospital, Alice Springs, Australia
Aim: To analyse the long-term outcome of endovascular interventions on arteriovenous dialysis access in a nephrology led interventional service.
Background: Vascular access dysfunction is one of the leading causes of morbidity and mortality among end-stage renal disease patients. Percutaneous endovascular or surgical procedures are treatment options to treat dysfunctional AVF and grafts. A nephrologist led endovascular interventional program was commenced in 2008 to improve the quality and efficiency of vascular access care. The program was primarily started as many fistulas were lost as patients had to travel in excess of 1500 kms to undergo a definitive procedure on their vascular access.
Method: This is a retrospective study of all fistuloplasties performed between 1st Dec 2008 and 31st Dec 2020. Data was collected from the medical and radiology records. Patients undergoing surgical interventions were excluded. Wilcoxon signed rank test was used. Survival analysis test was done to assess the cumulative and assisted patency of the vascular access.
Results: 248 patients underwent 846 interventions, an average of 2.9 fistuloplasties per vascular access were performed. The mean age was 57.5 yrs. 59 % were females, 86% had diabetes mellitus. The commonest fistula was brachiocephalic (64%) and only 7% were AVG. The most frequent sites of stenosis were Cephalic arch (32.98%) followed by multiple sites (21.40%), juxta-anastomotic (20.35%), peripheral (15.09%) and central regions (10.18%). The mean primary, secondary and cumulative patencies were 2.8yrs+/- 2.64SD, 2.02yrs+/- 7.4SD and 4.9yrs+/- 8.05SD which was statistically significant (p value 0.00). Median survival for Cumulative and assisted access patencies were 10.2yrs & 6.1yrs, respectively
Conclusions: Nephrologist led endovascular treatment of dysfunctional AVF and AVG significantly improved the survival of the vascular access.
David Kiran Fernandes has been a part of Renal services team at Alice Springs Hospital, Northern Territory since 2007 and he has been involved in the interventional work in Central Australia since its inception in 2008. He graduated from the St John’s Medical College, Bangalore, India. Completed post-graduation and became a Lecturer in the Department of Nephrology, St John’s Medical College, Bangalore, India. David has completed specialist training in renal medicine under the tutelage of the renowned nephrologist, Late Professor J.C.M Shastry. Other interests include music and sports.