Percutaneous transluminal angioplasty for failing native hemodialysis arteriovenous fistulas

Abstract

Background Stenosis and associated thrombosis is a continual complication of hemodialysis arteriovenous fistulas (AVFs). Early management of stenosis may avoid AVF occlusion and extend its use. Objective The objectives were to evaluate effectiveness, safeness, and durability of percutaneous transluminal angioplasty (PTA) in treatment of failing native hemodialysis AVFs. Patients and methods A total of 20 patients (12 females and eight males) with chronic renal failure dependent on hemodialysis underwent PTA for their failing native AVFs. The indications for these procedures were significant stenosis (>50% decrease of the vessel diameter). Results A total of 20 PTA procedures were performed in 20 fistulas of 20 patients with end-stage renal disease. These interventions were performed on 14 (70%) brachiocephalic and six (30%) radiocephalic fistulas. PTA succeeded technically in 18 (90%) procedures, and clinical success was accomplished after 17 (85%) procedures. The authors found the commonest site (65%) of AVF stenosis is in the juxtaanastomotic segment. Recurrent stenosis occurred in three (15%) patients; the three cases were subjected to a second successful PTA. The primary patency rates were 70% after 6 months and 50% after 12 months. The primary assisted patency rate was 100% after 12 months. A total of 12 (60%) patients required no further reintervention and continued hemodialysis from their fistulas till the end of the study. Conclusion PTA for treatment of failing native hemodialysis AVFs is a successful efficient technique to prolong the patency of the fistulas. By preserving the existing fistulas, venous segments can be saved for future AVF creation.