Management of vessel rupture during angioplasty of malfunctioning hemodialysis access

Purpose A review of the management of vessel rupture after angioplasty of malfunctioning hemodialysis access in a single tertiary institution. Materials and Methods A retrospective database of endovascular treatment for malfunctioning hemodialysis arteriovenous fistulas (AVF) and grafts (AVG) between January 2007 and August 2012 was obtained. 52 vessel ruptures (defined as contrast extravasation on post angioplasty angiogram) occurred in 41 patients (11 males) with mean age of 65 years (range 34-94). Recurrent ruptures occurred in 7 patients who underwent subsequent and separate angioplasty treatment. 1 patient had ruptures at 2 different sites during the same treatment session. Mean follow-up is 26 months (range 1-73). Results 35 ruptures occurred in AVFs and 17 in AVGs. 67.3% (35/52) was successfully managed with prolonged balloon tamponade across the rupture site. 19.2% (10/52) required either bare (n=7) or covered (n=3) mental stent deployment after failed balloon tamponade. 1.9% (1/52) was successfully managed with manual compression. 1.9% (1/52) required urgent surgical repair. In 9.6% (5/52), the hemodialysis access was abandoned. The cumulative primary patency rate was 88.5% at 6 months, 80.4% at 12 months, 58.7% at 24 months, and 39.6% at 36 months. The cumulative secondary patency rate was 86.3% at 12 months, 72.0% at 24 months, 57.7% at 36 months, and 24.9% at 48 months. The 30-day mortality was 1.9% (1/52). Conclusion The majority of vessel ruptures post-angioplasty can be managed effectively with balloon tamponade alone with satisfactory primary and secondary patency rates.