Percutaneous transluminal angioplasty as a treatment of stenosis of arteriovenous fistula for hemodialysis

Abstract

ObjectiveThe aim of our study is to evaluate the endovascular option for treatment of arteriovenous fistula (AVF) stenosis through assessment of success rates and primary patency rate after the angioplasty procedure.BackgroundThe quality of life of hemodialysis patients depends mainly on the patency and proper function of their vascular access. The main cause of AVF dysfunction is stenosis of the fistula. Vascular surgeons should have many surgical and endovascular plans to keep the hemodialysis access patent and functioning. Percutaneous transluminal angioplasty has become an established treatment of dysfunctional AVFs, with many advantages and benefits for the patients.Patients and methodsA prospective study was conducted on 30 patients having end-stage renal disease scheduled for or already on regular hemodialysis with failing or recently failed native AVF during February 2018 till February 2020. Balloon dilation was done alone in 27 cases, whereas it was combined with thrombectomy procedure with a Fogarty catheter in three cases.ResultsA total of 30 patients (19 males and 11 females) were included. Overall, 56.67% of AVFs were brachiocephalic AVF. Radial access was mostly used as an access in 80% of cases, whether percutaneous or surgical. Venous juxta-anastomotic stenosis was the most common site of stenosis (40.91%). Technical success rates in this study reached 86.67%, and the overall primary patency rates were 84.62 and 76.92% at 3 and 6 months, respectively.ConclusionBalloon angioplasty of failing or recently failed native AVF is a safe and effective procedure. It is associated with high success rates, low complication rates, and maintained long-term patency of the hemodialysis access.