Endovascular Treatment of Juxta-anastomotic Venous Stenoses of Forearm Radiocephalic Fistulas: Long-term Results and Prognostic Factors

Abstract

PurposeTo evaluate long-term results of endovascular procedures in treatment of venous juxta-anastomotic stenoses (JASs) of native forearm radiocephalic arteriovenous fistulas (AVFs) and to identify prognostic factors influencing these results. Materials and MethodsDuring a 124-month period, 147 endovascular interventions were performed in 75 forearm radiocephalic AVFs with JASs defined as stenoses located within the first 5 cm of the outflow vein. Prognostic factors included patient characteristics (age, sex, diabetes), AVF-related characteristics (location on forearm, age, maturity), stenosis-related characteristics (position relative to anastomosis, length, and degree), and degree of residual stenosis and delay of restenosis after the first endovascular procedure. ResultsAt 1 and 3 years, access primary patency (PP) rates were 46.6% (95% confidence interval [CI], 36.3%–59.9%) and 25.5% (95% CI, 15.7%–41.6%) and assisted PP (APP) rates were 81.3% (95% CI, 72.6%–91.1%) and 63.2% (95% CI, 50.6%–79.0%), respectively. Stenosis degree of 50%–75% (P = .017), stenosis length of 10 mm or more (P = .017), and time before first restenosis of less than 6 months (P = .03) significantly increased the frequency of endovascular procedures during follow-up. However, only the degree of residual stenosis after the first endovascular treatment significantly affected long-term APP (P = .039). When residual stenosis was less than 50%, 1- and 2-year access APP rates were 84.6% (95% CI, 75.8%–94.4%) and 76.1% (95% CI, 64.6%–89.6%), respectively. When it was at least 50%, the respective APP rates were 62.3% (95% CI, 38.9%–99.9%) and 46.8% (95% CI, 22.4%–97.7%). ConclusionsEndovascular treatment of JASs in forearm radiocephalic AVFs provides good long-term results except when the residual stenosis after the first procedure is 50% or more. In that case, the optimal treatment remains to be determined.