Long-term results of percutaneous transluminal angioplasty for hemodialysis shunt insufficiency.

Purpose: The purpose of this study was to evaluate the long-term results of percutaneous transluminal angioplasty (PTA) for stenosis and/or occlusion of dialysis shunts. Methods: One hundred thirty-nine stenosed or thrombosed dialysis shunts (99 native fistulae, 37 grafts) in 122 patients were treated by PTA. In 39 cases, additional PTA for restenosis was performed. In total, 230 PTAs were performed (1-10 PTA/shunt). Results: The initial success rate was 86% in cases without occlusion. In contrast, the success rate in cases with occlusion was 53%, significantly worse than in the cases without occlusion. In cases in which initial success was obtained, primary cumulative patency rates at 3, 6, and 12 months were 87%, 60%, and 40%, respectively. With repeat PTA, secondary cumulative patency rates at 3, 6, 12, and 24 months were 96%, 83%, 63%, and 55%, respectively. Patency of native fistulae was better than patency of grafts. There was no significant relationship between the anatomical location of the stenoses and the patency rates. Conclusion: PTA is an effective treatment for shunt stenosis; although primary patency after PTA is not sufficient, repeated PTA increases patency.