Ultrasound-guided angioplasty of dialysis fistulas in renal transplant patients

Abstract

Introduction: Percutaneous endovascular angioplasty has become the treatment of choice for dialysis fistula stenosis. The ultrasound-guided endovascular procedure is used in patients with severe renal impairment and advanced renal transplant failure, when the need for nephrotoxic contrast administration in standard angioplasty may worsen renal function. Aim: To evaluate endovascular angioplasty guided by ultrasound for dialysis fistula stenosis in renal transplant patients with severe graft insufficiency. Material and methods: We compared ultrasound (US)-guided angioplasty, performed in patients after renal transplantation, with standard contrast angioplasty performed in dialysis patients. We treated 10 kidney allograft recipients (9 kidneys and 1 kidney-pancreas) with significantly compromised renal transplant function and significant stenosis in dialysis fistulas, as detected during US examination. Patients were qualified for percutaneous angioplasty under US guidance. The mean period from transplantation was 32.7 months (5–100 months). Results of their treatment were compared to the control group of 20 end-stage renal disease patients with dialysis fistula stenosis treated by angioplasty under standard contrast visualization. Results: The immediate effectiveness of the angioplasty was 100% in both groups. No early complications of angioplasty or problems with the guidewire crossing the stenosis were observed. Twelve months of primary patency was observed in 80% and 45% in the US-guided and control groups, respectively. Conclusions: The US-guided endovascular procedure is an effective and safe method of treating dialysis fistula stenosis in patients with impaired renal transplant function.