Endovascular Salvage of Nonmaturing Autogenous Hemodialysis Fistulas: Comparison with Endovascular Therapy of Failing Mature Fistulas

Abstract

To evaluate the utility of endovascular salvage of nonmaturing autogenous hemodialysis fistulas in a prospective trial of consecutive patients compared with a historical group of patients who underwent treatment of failing mature autogenous fistulas. During a 12-year period, angiography revealed anatomic lesions in 75 fistulas with maturing problems (72 radiocephalic and three brachiocephalic). Endovascular therapy through antegrade arterial access was attempted in 72 fistulas. A series of 45 consecutive patients who underwent endovascular salvage of failing mature fistulas was used as a control group. A technical success rate of 88% (66 of 75) and a clinical success rate of 87% (65 of 75) were achieved for the nonmaturing fistulas. Including the secondary interventions, the rate of complications was 6.1% (eight of 131). By Kaplan-Meier analysis, the primary clinical patency rates were 43% +/- 6% (+/-SEM), 36% +/- 6%, and 23% +/- 6%, and the secondary patency rates were 76% +/- 5%, 68% +/- 6%, and 57% +/- 8% at 6, 12, and 36 months, respectively. A small inflow artery (<3 mm in diameter) predicted a poorer primary patency rate (28% +/- 10% vs 48% +/- 9% at 1 year; P = .01). The secondary patency rate of nonmaturing fistulas at 3 years was worse than that of mature fistulas, at 57% +/- 8% versus 79% +/- 8% (P = .02). A functional fistula was achieved in 87% of nonmaturing fistulas. Although the functional time gained in these fistulas is shorter than that gained in failing mature fistulas, more than half of nonmaturing fistulas are functional after 3 years.