Salvage procedures for failing arteriovenous fistula: “An institutional experience”

Abstract

Introduction: Arteriovenous fistula (AVF) is lifeline for patients with end-stage renal disease. A fistula should be mature enough to support efficient hemodialysis. The most important requirement is adequate blood flow through the fistula. This goal is achieved in most AVF. Few fistulas do not mature, i.e., there is inadequate blood flow through the fistula. In this condition, we may close this improperly functioning fistula and create fistula at another site. Closure or ligation of inadequate, but uncomplicated fistula, is not the norm. Another less utilized and described option is to perform some auxiliary procedures to salvage the fistula when indicated. Auxiliary procedure may also be necessary in conditions such as steal syndrome and venous hypertension (VH). We present our experience with some of these auxiliary procedures. Aims: The aim of the study is to retrospective analysis of fistula salvage procedures for failing fistulae in our institution. Settings and Design: This was a retrospective, observational study. Subjects and Methods: A retrospective analysis of AVF was performed during the past 2 years that failed to mature and support an efficient hemodialysis. Another group of patients who had either steal syndrome or VH were also reviewed. Auxiliary procedures were done on all these patients with encouraging results. Results: In four patients, ligation of collateral was done. In one patient in whom there was a side-to-side arteriovenous anastomosis, ligation of distal venous segment was done to reverse VH. Another four patients with steal syndrome underwent partial occlusion of the vein near anastomotic site. In nine patients, endovascular dilation and/or stenting of stenosed segment of the vein was done. Conclusions: In patients with suboptimally working fistula, a lesion-specific auxiliary procedure can salvage and enhance their performance.