Efficacy of percutaneous transluminal angioplasty in the management of chronic hemodialysis patients.

Percutaneous transluminal angioplasty (PTA) has gained wide acceptance as an effective technique for the dilatation of stenoses in the arterial tree. We evaluated the long-term results of vascular access in a group undergoing hemodialysis, in particular the effects of PTA. Twenty-four percutaneous procedures were performed on 18 patients. Detection was based on physical examination, flow rate measurements, venous pressure, and analytical determinations performed at dialysis. The initial success rate was 87.5%, with 1-, 6-, and 18-month patency rates of 82.6, 67.5, and 38.5%, respectively. There was no difference between primary and secondary patency rates. The assisted primary patency rates for PTA and surgical revision were not significantly different. Although neither surgical nor endovascular management resulted in long-term function for the majority of shunts after stenosis or thrombosis, endovascular treatment can extend the life of dialysis shunts with results similar to surgical revision. Transluminal dilatation may be performed in appropriate cases to obviate the need for surgery.