Nephrol Dial Transplant (2002) 17: 843-851
© 2002 European Renal Association-European Dialysis and Transplant Association
Arterial percutaneous angioplasty in upper limbs with vascular access devices for haemodialysis
1 Department of Cardiovascular Radiology, Clinique Alleray Labrouste, 64 Rue Labrouste, F-75015 Paris, 2 Department of Radiology, Hôpital Broussais, Paris, France, and 3 Department of Nephrology, Hospital de S Bernardo, Setúbal and Clínica de Doenças Renais, Lisbon, Portugal
Background. The purpose of this study was to evaluate retrospectively the clinical context and effectiveness of arterial percutaneous transluminal angioplasty (PTA) of arterio-venous fistulae in chronic haemodialysis patients.
Methods. Between May 1992 and June 1997, arterial PTA was performed in 33 patients with a total of 35 angioaccess devices of the upper limbs (18 arterio-venous fistulae and 17 PTFE grafts). Clinical indications for arterial PTA were unexplained acute thrombosis in 12 patients (34.3%), insufficient blood flow in 13 patients (37.1%), and severe limb ischaemia in 10 patients (28.6%), two of whom had skin ulcerations and one had severe neurological damage. Follow-up periods varied between 1 and 55 months (mean 15.5 months).
Results. PTA was attempted in 22 radial, 10 brachial and seven ulnar arteries. Angioplasty was successful (i.e. residual stenosis of 
30%) in all but one patient. There were no complications. Early re-thrombosis (<1 month) occurred in two of the 12 patients with acute occlusions. All the angioaccesses of patients with insufficient blood flow were improved. Eight of the patients with limb ischaemia became symptom free, and two were failures (one had partial healing of skin ulcerations and one did not improve). Re-stenosis occurred in six cases (27.3% of the 22 angiograms performed) but re-dilatation was performed in only two instances. Primary and secondary patencies were 63.5 and 90.6% at 6 months and 40.8 and 75.6% at 24 months, respectively.
Conclusion. Chronic arterial lesions in upper limbs bearing vascular access devices for haemodialysis may lead to thrombosis, ischaemia and insufficient flow for dialysis treatment. PTA is a safe and effective technique with a low rate of re-intervention.
Keywords: arterial stenosis; haemodialysis; ischaemia; PTA; thrombosis; vascular access
Correspondence and offprint requests to: Alexandra Guerra, Clínica de Doenças Renais, Av. Forças Armadas, 49 R/C, 1600-076 Lisboa, Portugal. Email: alex.jluc{at}oninet.pt
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