Factors That Influence Patency of Post-Endovascular Fistula Salvage Procedure in Arteriovenous Fistula Dysfunction

Abstract

Introduction: Beyond the primacy of arteriovenous fistulas (AVF) as hemodialysis access, AVF is not always free of problems. Although the incidence of stenosis and thrombosis is low, these two obstacles can still occur. The development of endovascular fistula salvage (EFS) procedures can be a solution for non-immature AVF, stenosis, or thrombosis for functional return. There are limited factors known to support the success of EFS in patients with characteristics that exist in Indonesia. Method: People with AVF dysfunction (n = 107) performed by EFS were evaluated in a retrospective cohort between November 2015 and November 2017 to obtain a picture of post-EFS patency and was assessed for the relationship between anatomic variation, diabetes mellitus, and patient age with post-EFS AVF patency. Results: There were 133 stenoses with 66 stenoses in juxta anastomosis, 7 in feeding arteries, and 60 in draining vein fistula. The average length of the stenosis is 21.5 mm. Residual stenosis of more than 30% was found in 21 cases (15.8%). Variables that affected dysfunction were age (p = 0.038) and diabetes (p = 0.035). In this study, it was found that multiple stenoses also affected primary patency (p = 0.008). Primary patency in the first 6 months and 12 months was 82.2% and 74.8%, respectively. Complications were found in 8 cases (7.47%). Conclusion: EFS procedure on dysfunctional AVF can be the first choice compared to new AVF creation actions or heavenly revision actions. Keywords: endovascular fistula salvage, arteriovenous fistula dysfunction, percutaneous transluminal angioplasty