OBJECTIVE: Repeated percutaneous interventions on failing @entity2548 ( @entity2548 ) and @entity2758 ( @entity2758 ) for hemodialysis are common, but the outcomes are largely unknown. We sought to determine the results of the second percutaneous intervention on failing @entity2758 and @entity2548 and to identify factors associated with loss of patency. METHODS: For the purpose of this study, the second percutaneous intervention was identified as the index procedure. We reviewed the second percutaneous interventions on failing @entity2548 and @entity2758 at a single institution between 2007 and 2013. @entity1 comorbidities, graft or fistula configuration, lesion characteristics, and procedural characteristics of the intervention performed were analyzed with respect to technical success, primary patency, primary assisted patency, and secondary patency. Patency was defined per Society for Vascular Surgery recommended reporting standards and was determined from the time of the index procedure. Cox proportional hazards multivariable modeling was performed to identify independent determinants of loss of patency. RESULTS: Among 91 @entity1 , 96 second-time percutaneous interventions were performed on 52 @entity2548 and 44 @entity2758 . @entity1 included 56% @entity1 and 44% @entity1 with a mean age of 64     17  years. The lesions intervened on were primarily located along the accessed portion of the outflow in @entity2548 and within the length of the graft and at the venous anastomosis in @entity2758 . Transluminal angioplasty alone was performed in 82 procedures (85%), and uncovered or covered stents were placed in 15 procedures (16%). Pharmacomechanical thrombectomy was performed in 32 @entity1 (34%) and was more commonly performed in @entity2758 compared with @entity2548 (53% vs 17%; P  = .0002). Technical success was achieved in 90 procedures (97%; n  = 92). One-year primary patency, assisted primary patency, and secondary patency rates were 35%, 86%, and 86%, respectively. One-year primary patency did not differ between @entity2548 and @entity2758 , but secondary patency was lower for AVG in comparison to AVF (P  = .04). On multivariable analysis, only the need for pharmacomechanical thrombectomy significantly predicted failure of primary patency (hazard ratio, 2.6; 95% confidence interval, 1.6-4.3). The presence of an AVG rather than an AVF independently predicted failure of secondary patency (hazard ratio, 2.9; 95% confidence interval, 1.0-8.2). CONCLUSIONS: The second percutaneous interventions on @entity2548 and @entity2758 are associated with excellent technical success but poor primary patency. The need for pharmacomechanical thrombectomy predicts the need for additional percutaneous intervention to maintain patency. With additional interventions, acceptable secondary patency out to 5  years can be achieved, although @entity2758 have inferior secondary patency to @entity2548 . To develop optimal practice management algorithms, the effectiveness of repeated percutaneous interventions for failing @entity2758 and @entity2548 vs creation of a new access should be further investigated.

Results of repeated percutaneous interventions on failing XXXX and grafts and factors affecting outcomes.

@entity1 :: ('9606', 'Species') :: ['women', 'Patients', 'patients', 'Patient', 'men'] @entity2548 :: ('MESH:D001164', 'Disease') :: ['AVFs', 'arteriovenous fistulas'] @entity2758 :: ('MESH:D001165', 'Disease') :: ['arteriovenous grafts', 'AVGs']
@entity2548 :: (MESH:D001164,Disease) :: ['arteriovenous fistulas']
