W. Perry Arnold, MD
Background: As interventional radiologists perform an increasing number of procedures on hemodialysis access sites, they will recognized a small cohort of patients (approximately 5-10%) who will fail not only declotting procedures but also surgical interventions. Suggestions relative to a patient profile include gender female; diabetic; and > 65 years old. As this describes approximately 50% of the dialysis population, a better identification method is needed.
Materials and Methods: In a large interventional radiology practice dedicated to dialysis access, a retrospective chart review yielded more than 2,000 cases that were performed from October 1997 until June 1999. (n= 2092) Of those cases, 213 (9.32%) or 54 patients out of the 928 (7.5%) were defined as frequent failures.
Results: Overall, there were 2.35 procedures per patient during the study period. Frequent failures had a mean of 3.34 procedures per patient. Non-frequent failure patients had an average of 1.19 procedures.
Long term patency for the frequent failure group was poor:
| # of procedures | 1 month | 3 months | 6 months | 12 months | median |
| 213 | 46% | 22% | 7% | <1% | <1 month |
Regression analysis yielded the following pertinent variables: gender, diabetic status and age.
Conclusion: Identification of potential frequent failure patients is critical to success. Closer monitoring and surveillance may yield better outcomes. Development of a risk model will be the key to long term successful outcomes in these technologically difficult patients.