Outcomes of endovascular procedures in salvage of arteriovenous fistulas via the transradial route: A prospective study

Abstract

Aim: To evaluate the primary patency and predictors of technical failure of arteriovenous fistulae (AVF) following transradial percutaneous transluminal angioplasty (PTA). Materials and Methods: This was a prospective study being conducted to evaluate the primary patency and predictors of technical failure of AVF following transradial PTA. This will help us identify high-risk patients and plan interventions in them at an earlier time to avoid access loss. The time period of the study was from October 2016 to October 2018 in the Department of Vascular and Endovascular Surgery at Sri Ramachandra Medical College, Chennai, Tamil Nadu. A total of 44 patients were included in this cohort and they were all followed up in the outpatient department and via telephonic contact for a period of 1 year. All the patients who underwent endovascular AVF salvage fitting the inclusion criteria were included in the study. The demographics of the patients were recorded at admission and patients were investigated for the cause of fistula dysfunction at the treating physicians discretion and an ultrasound Doppler was ordered for all patients to ascertain the cause of the stenosis. The statistical analysis was done by the ANOVA and t-test. Results: A total of 44 patients were included in this cohort and they were all followed up for a period of 1 year. The 30-day, 90-day, 6-month, and 12-month primary patencies were 84.1%, 81.8%, 63.63%, and 43.18%, respectively. Our technical success was 88.6%. In our study, we found that longer lesion lengths (>4 cm) were prone to early loss of primary patency and this was statistically significant. We found that patients above 60 years of age had lower primary patencies and the presence of diabetes mellitus also lowered the primary patency. Fistula maturation age did not show a correlation with patency in our cohort. Male patients had a higher patency rate and juxta-anastomotic stenoses postangioplasty had a higher primary patency due to the shorter lengths. Radiocephalic fistula angioplasties had a higher patency as compared to brachiocephalic angioplasty. Conclusion: Ours is the first study in India to proactively and preferably use the transradial approach over the transvenous approach, as it confers many benefits. The challenges of the transradial route are the smaller size of the radial artery in the Indian population as compared to the western population.