Endovascular Salvage Procedures in Increasing the Longevity of Hemodialysis Access

Abstract

Introduction: The leading cause of failure for an autogenous or prosthetic arteriovenous hemodialysis access is venous anastomotic stenosis & central venous stenosis. Endovascular procedures have come a long way in treating such lesions without significant postoperative morbidity and reliable technical success rates.This study aims at studying the long term results of such central venous and anastomotic site stenosis treated with endovascular approach in our centre. Materials and Methods: A total of 26 patients were treated, for a duration of 33 months between March 2012 to November 2014 with central venous, anastomotic site angioplasty ± stenting. Patients were followed up for 9 months. We had re-intervention in 3 cases. Results: Inadequate dialysis, thrombosed graft were the commonest presenting symptoms. Primary patency at the end of 15 months was 34.6% (9 patients), & at the end of 20 months was 11.5 %( 3 patients). Conclusion: Endovascular treatment with angioplasty or stenting for central venous stenosis & access salvage is safe, with low rates of technical failure. Only angioplasty without stenting seems by far the preferred approach, since it is less invasive, highly repeatable.