W. Perry Arnold, MD

Purpose: To determine whether or not the size of the balloon used for venous outflow stenosis angioplasty has an effect on primary patency in the recanalization of thrombosed hemodialysis vascular access grafts.

Materials and Methods: In a retrospective review of hemodialysis access management, 69 patients were identified who had been successfully treated on different occasions for thrombosis of a synthetic graft access using either 6mm or 8mm balloon angioplasty of a venous outflow stenosis. PTA was performed at the same site in the same access circuit with no intervening surgical correction of venous stenosis. The method of declotting was the same in comparison procedures. Primary patency for each procedure was determined through follow-up with the patients, dialysis centers and radiology clinical charts. Since the patients were the same for each series, they served as their own controls. No other variables influenced outcomes.

Results: The 86 venous PTA procedures using a 6mm balloon had a median primary patency of 2.5 months compared to median primary patency of 4.5 months for the 112 procedures using 8mm venous PTA. Both groups demonstrated three complications, venous rupture with associated significant hematoma formation. All were treated by balloon tamponade and remained functional. None required additional treatment. A table of primary patency for both sets of PTA is as follows:

Conclusion: 8mm venous angioplasty significantly increases primary patency of endovascular recanalization procedures for vascular access in dialysis patients when compared to patency of 6mm venous angioplasty. Complications are not significantly different.