Patch Angioplasty for the Treatment of Hemodialysis Access Dysfunction

Abstract

Background

The treatment of hemodialysis access dysfunction include creating a new fistula, balloon dilation, or stent implantation. However, these options are not suitable for all patients. We adopted patch angioplasty to reconstruct the hemodialysis access and observed this group of cases to evaluate the feasibility, effectiveness, and safety of this surgical method.

Methods

Between 2021 and 2024, we performed 14 cases of patch angioplasty using PTFE patch material. We recorded the time of fistula establishment, time of patch angioplasty, surgical site, transitional dialysis status using central venous catheter, complications, and patency of the fistula in this group of cases.

Results

All 14 patients successfully underwent patch angioplasty, with a technical success rate of 100%. During follow-up, 3 patients died respectively 2, 8, 9 months post-operation. The longest follow-up time was 38 months. The primary patency rates for target lesions were as follows: 92.3% at 3 months (12/13), 81.8% at 6 months (9/11), 77.8% at 12 months (7/9), and 57.1% at 24 months (4/7). The cumulative patency rates were: 3 months 100% (13/13), 6 months 90.9% (10/11), 12 months 88.9% (8/9), and 24 months 71.4% (5/7). No cases experienced infection, bleeding, pseudoaneurysm, or steal syndrome.

Conclusions

PTFE patch angioplasty for hemodialysis access reconstruction yields a high technical success rate and serves as an effective solution after hemodialysis access dysfunction. It has high safety and good patency rates, making it a recommended method for access reconstruction.