W. Perry Arnold, MD
Background: In the late 1980's, it became apparent that the leading cause of morbidity in the End Stage Renal Disease (ESRD) patient is failed vascular access. It was at that time that a group of radiologists developed a focused approach to access care.
Materials and Methods: A retrospective data review of procedures identified 928 patients for a total of 2092 procedures in the time frame of October 1997 through June 1999. This patient population was out of a total dialysis population of 1,500-2,000. Procedures performed included: Declots (47%, n=990); Angiography witb PTA (22%, n=470); Tunneled catheter placement (20%, n=423); Angiography without treatment (9%, n=188) and other access procedures (2%, n=47). Several cases had multiple procedures performed.
Results: Initial success rates were excellent when compared to the literature.
Declots (including fistulae): 92%
Catheter Placements: >99%
Patency indicated successful long term results as well:
| Procedure | Number | 1 month |
3 months |
6 months |
12 months |
Median |
| Declots | 518 | 71% | 55% | 44% | 21% | 4.3 months |
| Assisted Patency | 57 | 96% | 91% | 82% | 39% | 10.6 months |
| Frequent Failures | 213 | 46% | 22% | 7% | <1% | <1 month |
| Declots excl. failures | 305 | 89% | 78% | 70% | 35% | 9.4 months |
Complications were minimal (overall <2%) with a major complication rate of 1.6%; a minor complication rate of 2%; an angio/PTA complication rate of 1% and a catheter complication rate of 1%.
Conclusion: ESRD patients requiring a catheter or declotting of a graft or fistula can be successfully treated in an outpatient radiologic intervention center.