Duplex Guided Dialysis Access Interventions can be Performed Safely in the Office Setting: Techniques and Early Results

Objective: To determine the utility of duplex guided angioplasty for hemodialysis access maturation and maintenance. Design/Materials/Methods: Between January 2008 and June 2009, 223 office-based duplex-guided hemodialysis access angioplasty procedures were performed in 125 patients. Two hundred eight of the accesses were autogenous. The most common indication for intervention was maturation failure (104 cases). Other indications included pulsatility, low access flow, decreased flow and infiltration. Procedures were performed in the office using topical and local anesthesia. Volume flow (VF) was recorded prior to introducer insertion (baseline) and post intervention. Results: Technical success was achieved in 219 cases (98.2%). Minor complications occurred in 21 cases (9.4%). Immature autogenous AV accesses had a median baseline VF of 210 mL/min. Median final VF for these autogenous AV accesses was 485 mL/min. The VF increased by 131%. Dysfunctional autogenous AV accesses and nonautogenous AV accesses had a median baseline VF of 472 mL/min. Median final VF was 950 mL/min. The VF increased by 101%. Conclusions: Duplex guided dialysis access angioplasty can be performed safely and effectively in the office setting. It offers the advantage of treating the patient without radiation or contrast as well as the assessment of the hemodynamic effects of intervention. (C) 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.