Arteriovenous grafts in hemodialysis patients are prone to recurrent stenosis and require interventions to optimize their long-term patency. However, traditional intervention approaches have several limitations, including the risk of early rethrombosis due to the need for direct compression after the intervention and the risk of distal embolization [Lilly et al. Am J Kidney Dis 2001; Turmel-Rodrugues et al. Nephro Dial Transplant 2000]. Ali A. Youssef, MD, Suez Canal University Hospital, Ismailia, Egypt, presented the results of a study that showed that transradial percutaneous transluminal angioplasty (PTA) of brachiobasilic hemodialysis access grafts is feasible and safe and has a high success rate.

This prospective study enrolled 35 consecutive patients (63 procedures) with dysfunctional brachiobasilic hemodialysis access grafts between January 2003 and January 2007. Technical success was defined as >50% residual stenosis and normal flow, as defined by the protocol. Clinical success was defined as the ability to complete one full hemodialysis session using the repaired access. The data were analyzed on an intent-to-treat basis (ie, all 35 patients [63 procedures] were included). Subjects had a mean age 58 years; 43% was male. The mean shunt age was 22.14 ± 15.8 months (range 7 to 38). Forty percent of patients were diabetic, and 46% had hypertension. In the vast majority of cases, thrombosis was present in the venous outflow (91%) and/or at the graft site (88.7%). Approximately 40% of patients were being treated for a restenosis after a prior intervention, mostly a second occurrence (25%). The mean duration of access dysfunction was 2.2 ± 1.1 days.

Access time was ∼3 minutes; mean procedure time was 47.4 ± 29.1 minutes. Balloon size was 7 mm in 66% of procedures and 6 mm in 21.3% of procedures. Central vein PTA was required in 3.3% of procedures. Mean residual stenosis was 24.2% ± 20.5. Final residual stenosis was <30% in 66% of procedures and <50% in 89% of procedures. Clinical success was achieved in 89% of procedures in the cases. Primary and primary assisted patency rates at 3, 6, 9, and 12 months are shown in Table 1. There was one case of access failure and one case of wiring failure. Complications occurred in 9.5% (6/63) of procedures: 3 cases of venous dissection and one case each of extravasation, perforation, and radial artery dissection.

The results of this modestly sized feasibility study support PTA of brachiobasilic hemodialysis access grafts as a potentially safe and effective method for restoring graft patency.