Abstract
Abstract Background: Arteriovenous fistula (AVF) is a significant procedure for patient in need of hemodialysis. Failure of maturation due to stenosis is a challenge that needs further intervention. Endovascular treatment allows salvaging these fistulae. Aim of the work: To identify the anatomical causes of maturation failure and to assess immediate and long-term clinical effects of PTA of non-mature native (AVF) caused by outflow stenosis using currently available endovascular techniques. Materials and Methods: This study was performed on forty patient complaining of stenosis of primary AVF. The mean age is 60.5. Patient were followed-up every two weeks for the first 2 months, then every month for 6 months post-intervention clinically and radiologically. Collected data includes patient's demographics, cause of renal failure, characters of primary AVF, variables of endovascular intervention, primary patency, and recurrence of stenosis. Results: AVF type was either brachiocephalic (57.5%), brachiobasilic (32.5%) or radiocephalic (10.0%). Fistulography revealed peripheral venous stenosis in 18 patient (45.0%), central venous stenosis in 14 patient (35.0%) , and juxta-anastomotic stenosis in 8 patient (20%). Our technical success was achieved in 87.5% of cases; the patency rate was 91.0% in a month , 86.0% in 3 months , and 80.0% in 6 months. Complications were reported in 10 cases. The recurrence was reported in 7 patient (17.5% of cases). Conclusion: Endovascular salvage of failing A-V fistulas with PTA and Stenting is safe and effective. It is associated with high success rates, low complication rates, and rendering the immediate reuse of the failing shunt.
Highlights
Chronic end-stage renal disease (ESRD) patients need replacement renal therapy
Regarding endovascular intervention were done through a transvenous retrograde approach in 23 cases (57.5%) and trans-venous Antegrade approach in 17 cases (42.5%), the percent of stenosis varies from mild stenosis to total occlusion
The creation of patent arteriovenous fistula considered as the cornerstone for the starting of hemodialysis which is the mainstay in the treatment of chronic (ESRD)
Summary
Chronic end-stage renal disease (ESRD) patients need replacement renal therapy. Native arteriovenous fistula (AVF) is considered as the primary and best vascular access method for renal hemodialysis.[1]In comparison with synthetic grafts and central vein catheters, the native AVF is associated with a low rate of complications, had a low revision rate, costs[2], and low mortality rate. 3 On the other side, AVF had the disadvantage of being associated with a relatively high rate of failure of maturation and early thrombosis. 5. The reported rate is extending between 24 and 60% of failure to mature in studies from American and European hemodialysis patient, respectively.[6,7,8,9]. Native arterio-venous fistulae (AVF) failure of maturation is a challenging matter in the establishment of functioning hemodialysis vascular access. Aim of the work: To identify the anatomical causes of maturation failure and to assess immediate and long-term clinical effects of PTA of non-mature native (AVF) caused by outflow stenosis using currently available endovascular techniques. Collected data includes patient's demographics, cause of renal failure, characters of primary AVF, and variables of endovascular intervention, primary patency, and recurrence of stenosis. Conclusions: Endovascular salvage of failing A-V fistulas with PTA and Stenting is safe and effective It is associated with high success rates, low complication rates, and rendering the immediate reuse of the failing shunt.
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