Arteriovenous Access Research Articles

Central blood volume and cardiac output index predict all-cause and cardiovascular mortality in chronic hemodialysis patients.

This study investigated the effect of central blood volume (CBV) and cardiac output index (COI) on the all-cause and cardiovascular mortality in chronic hemodialysis (CHD) patients. Adult CHD patients with functional arteriovenous access at the hemodialysis center of a medical center between January 1, 2003, and December 31, 2014, were recruited in this retrospective observational study. The primary and secondary endpoints were all-cause and cardiovascular mortality. Cumulative incidences of all-cause and cardiovascular mortality during the follow-up period were estimated and compared using the Kaplan-Meier method and log-rank test. Logistic regression and Cox proportional hazards models were used to calculate odds and hazard ratios. A total of 390 CHD patients were enrolled, including 34 patients with early mortality. The early mortality group had a higher CBV than the survival group. CBV and COI were independently associated with all-cause and cardiovascular mortality. Low COI (< 3 L/min/m2) and high CBV (≥ 1.25 L) independently predicted long-term all-cause and cardiovascular mortality. The highest risks of all-cause and cardiovascular mortality were observed in patients with low COI and high CBV, followed by high COI and high CBV and then low COI and low CBV. Mortality was the lowest in those with high COI and low CBV. CBV and COI are important factors for predicting death in CHD patients. Those with low COI and high CBV had the worst outcomes.

Long-Term Arteriovenous Access Clinical Patency Following Successful Thrombolysis: A Single-Centre Experience.

Introduction There is a paucity of data regarding the long-term outcomes following thrombolysis of arteriovenous (AV) access for dialysis. The aim was to determine the technical and clinical success following thrombolysis of a thrombosed AV access and the long-term clinical patency and access survival in our institution. Methods Retrospective identification of all patients undergoing thrombolysis of an AV access, AV fistula (AVF), or graft (AVG) over eight years at a single institution. Patient characteristics, access type, type of thrombolysis, and fistula life were recorded. Data were censored for death, transplantation, and loss to follow-up. Results Ninety-eight vascular accesses (79 AVF and 19 AVG) in 94 patients underwent thrombolysis during the study period. Fifty-three (56.4%) were male with a median(interquartile range [IQR]) age of 66 (53-74) years. Immediate technical and clinical success were 82% and 75%, respectively. Clinical patency following clinically successful thrombolysis at three, six, and 12 months was 64.5%, 60%, and 45.9%, respectively.At two and three years, clinical patency was 21.3% and 7.9%, respectively. AVFs were older than AVGs, 96 (44-192) vs. 20 (12-76) months, p<0.0001 at the time of thrombolysis. 21% of AV accesses that had successful thrombolysis and restoration of clinical patency re-presented with thrombosis after a median (IQR) of 185 (93.5-358) days and underwent further thrombolysis. AVGs (47.4%) were more likely to have re-thrombosed after successful thrombolysis than AVFs (15.2%), p=0.002. Kaplan-Meier survival analysis demonstrated that AVFs remained patent for longer than AV grafts (p=0.023) following successful thrombolysis.While in the short term, clinical patency was re-established, overall, there was no AV access survival advantage (p=0.085) over those that only required one episode of thrombolysis to restore access patency. Conclusions Endovascular strategies for dealing with thrombosed access are clinically important in allowing haemodialysis to continue. However, the clinical patency rates, while good in the short term, fail to be sustained long term. We propose that an episode of AV access thrombosis and successful thrombolysis should prompt a review of previous access-related interventions, age of AV access, and planning for alternative AV access options, be it new AV access formation, transplant, or long-term catheter placement.

Dialysis Associated Steal Syndrome Evaluation that uses Photoplethysmography and Arterial Indices

Dialysis-associated steal syndrome (DASS) is an uncommon disease that can be detected with careful and precise sonographic techniques. Arteriovenous (AV) access surgery is performed for patients with end-stage renal disease (ESRD) requiring regular hemodialysis. DASS is defined as retrograde flow in the native artery, distal to the AV access anastomosis. The blood direction reverses and re-routes flow from the distal extremity into the proximal, surgically created AV access vein or graft. Without detection and treatment, tissue loss to the extremity can occur. A wrist brachial index (WBI) and digital brachial index (DBI) evaluation utilizing photoplethysmography (PPG) is useful to confirm suspected DASS and determine the stage or severity of the steal. Sonographers familiar with WBI will notice a change in protocol when evaluating a patient for steal syndrome. This advanced Doppler technique is demonstrated in the case of a patient with a brachiocephalic fistula and symptoms of DASS. A deeper understanding of steal syndrome and how to perform this uncommon examination could improve outcomes for patients with DASS.

G-286 Features of the Mechanism of Development of Pulmonary Hypertension in Patients Undergoing Hemodialysis Through Arteriovenous Access

G-286 Features of the Mechanism of Development of Pulmonary Hypertension in Patients Undergoing Hemodialysis Through Arteriovenous Access

Efficiency of the Viabahn® Covered Stent-Graft as Salvage Treatment for Failing Hemodialysis Accesses.

Efficiency of the Viabahn® Covered Stent-Graft as Salvage Treatment for Failing Hemodialysis Accesses.

Six-month safety and efficacy outcomes from the randomized-controlled arm of the WRAPSODY Arteriovenous Access Efficacy (WAVE) trial.

Six-month safety and efficacy outcomes from the randomized-controlled arm of the WRAPSODY Arteriovenous Access Efficacy (WAVE) trial.

Adressing Hemodialysis Nurse Cannulation Anxiety

Introduction: While existing literature primarily addresses patient cannulation anxiety, the anxiety experienced by hemodialysis (HD) nurses is frequently overlooked. HD nurse cannulation anxiety occurs when HD nurses experience nervousness prior to and during cannulation procedures. Enhancing understanding of this phenomenon can facilitate the identification of its causative factors and support the development of effective strategies to address this critical issue. Method: This commentary was informed by a comprehensive literature review and insights gathered from informal dialogue with nurses possessing 1 to 27 years of experience in HD. Results: Cannulation anxiety among HD nurses negatively impacts their mental well-being and performance, potentially resulting in adverse patient outcomes. Causative factors of HD nurse cannulation anxiety include deficiencies in training and education, patient cannulation anxiety, limited availability of arteriovenous accesses in the clinical setting, and socio-demographic factors specific to HD nurses. Strategies to address HD nurse cannulation anxiety include prioritizing ongoing cannulation training throughout HD nurses’ careers, the utilization of virtual reality-based cannulation training programs, enhancing HD nurses’ proficiency with point-of-care ultrasound machines, and the implementation of proactive measures to mitigate the impact of socio-demographic factors on the development of HD nurse cannulation anxiety. Conclusion: Given the severity of its implications, addressing HD nurse cannulation anxiety should be a top priority for dialysis centers globally. Mitigating HD nurse cannulation anxiety can lead to substantial improvements in the overall care of HD patients and greater utilization of arteriovenous accesses, thereby enhancing HD patients’ health outcomes.

A 1-year follow-up analysis of a post-market surveillance study of a self-expanding endoprosthesis for stenosis or occlusion at the arteriovenous access.

To assess 1-year safety and efficacy of the Gore® Viabahn® Endoprosthesis self-expanding (SX) stent graft when used to treat stenosis or thrombosis at the venous anastomosis of synthetic arteriovenous access graft (AVG). This prospective, multicenter, post-market surveillance study evaluated the SX stent graft when used to treat stenotic or thrombosed vascular access circuits at the venous anastomosis of synthetic AVGs. Safety outcomes of adverse and serious adverse events were assessed. Efficacy outcomes of Kaplan-Meier (KM) estimates of primary patency and secondary patency of both the target lesion and the vascular access circuit, were evaluated through 1 year. In 103 patients, the stent graft was implanted with placement at the venous anastomosis of stenotic and thrombosed AVGs; 28 patients (27.2%) had elephant trunk placements. In 12 (11.7%) patients, devices were placed across the elbow. Through 1-year, KM estimates of primary patency for the target lesion were 52.7% (95% CI: 41.9, 62.3) and for the vascular access circuit 35.9% (95% CI: 26.2, 45.7). Secondary patency for both the target lesion and the vascular access circuit was 91.5% (95% CI: 83.8, 95.7). Mean cumulative number of reinterventions at 12 months was 0.69 (95% CI: 0.48, 0.90). The rate of device-related adverse events was 36.2%. There were two procedure-related events, and no device defects reported. This 1-year surveillance study of stent grafting at the venous anastomosis with the GORE® VIABAHN® SX stent graft, for treatment of stenotic or thrombosed synthetic AVGs, demonstrated acceptable safety outcomes.

Characterization of Protein Expression and Signaling Pathway Activation That May Contribute to Differential Biological Functions in Porcine Arterial and Venous Smooth Muscle Cells.

Arteriovenous fistulae (AVF) are the preferred mode of dialysis vascular access but have a maturation failure rate of over 50%. Venous segment stenosis is one of the main reasons. However, the reasons for the prevalence of stenosis in the venous segment, as opposed to the arterial segment, remain unknown. We hypothesize that differences in the protein expression profiles and in the activation of key signaling pathways of the vascular smooth muscle cells (VSMCs) in these two segments may contribute to this difference. In this study, arterial porcine VSMCs (ApSMCs) and venous porcine VSMCs (VpSMCs) were isolated to examine relevant protein expression and cell signaling pathway activation via Western blots and immunofluorescent staining. Our results revealed that growth-medium-stimulated cell proliferation was significantly higher in VpSMCs compared to ApSMCs, but no difference was detected in PDGF-BB-stimulated proliferation. VpSMCs migration was significantly greater than ApSMCs under both the serum-free condition and in the growth medium condition. In addition, VpSMCs appeared more susceptible to PDGF-BB-stimulated cell dedifferentiation. Furthermore, P53, vitronectin, collagen 1A1 and integrin β3 had lower expression in VpSMCs, whereas fibronectin, FAK, VCAM-1, MMP-9, TIMP-2 and TIMP-3 had higher expression as compared to ApSMCs. Meanwhile, PDGF-BB stimulated P38, JNKs and AKT activation, which were more potent in VpSMCs. Our results identify significant differences between VpSMCs and ApSMCs in the expression of functional proteins and the activation of signaling pathways, which may be responsible for more aggressive venous-as compared to arterial-stenosis in the clinical setting of arteriovenous access or other similar procedures.

Associations Between Type of Hemodialysis Access and Pulmonary Hypertension: A Single-Center Retrospective Cohort.

Pulmonary hypertension affects patients with hemodialysis-dependent end-stage kidney failure; however, the estimated prevalence varies greatly due to the underutilization of right heart catheterization and the evolving diagnostic criteria of pulmonary hypertension. Pulmonary hypertension in end-stage kidney failure is often attributed to arteriovenous (AV) access; therefore, we hypothesized that patients with AV fistula/graft would have a greater prevalence of pulmonary hypertension on right heart catheterization compared to those with central venous (CV) catheter accesses. In this retrospective single-center cohort study, we identified and randomly sampled patients from July 2012 to August 2022 receiving hemodialysis for ≥ 3 months and who underwent right heart catheterization, using Current Procedural Terminology codes. Pulmonary hypertension was defined as mean pulmonary arterial pressure (mPAP) > 20 mmHg. Our primary outcome was the prevalence of pulmonary hypertension among patients with AV fistula/graft versus CV hemodialysis access, tested with descriptive statistics. We evaluated survival as a secondary outcome using a Cox proportional hazards model. A total of 3834 patient charts were extracted. Overall, 444 charts were randomly sampled, resulting in 137 subjects meeting the inclusion criteria. The mean age was 63.8 ± 10.5 years, and 62% were male. The most common etiology of end-stage kidney failure was diabetic kidney disease (57.7%). Eighty percent of end-stage kidney failure patients had pulmonary hypertension; however, the type of hemodialysis access was not associated with pulmonary hypertension (85% CV catheter vs. 79.5% AV access, p = 0.59). Patients with pulmonary hypertension had lower hemoglobin (9.6 ± 0.8 vs. 11.2 ± 1.3 g/dL, p < 0.0001) and serum albumin (2.3 ± 0.9 vs. 3.4 ± 0.6 g/dL, p < 0.0001) than those without pulmonary hypertension. Those with pulmonary hypertension had an increased risk of mortality (hazard ratio: 2.2, 95% confidence interval: 1.04-4.61; p = 0.04). Our findings show a high burden of pulmonary hypertension among this heterogeneous cohort of end-stage kidney failure patients, with no association between pulmonary hypertension and the type of hemodialysis access. This study highlights the need for prospective investigations incorporating current strategies for pulmonary hypertension diagnosis and treatment among the dialysis-dependent population.

Myostatin Exacerbates Endothelial Dysfunction Induced by Uremic Toxin Indoxyl Sulfate and Is Associated with Hemodialysis Arteriovenous Access Complications.

Hemodialysis patients exhibit endothelial dysfunction, contributing to elevated cardiovascular risk and complications of the arteriovenous access. These patients have elevated serum levels of myostatin, a member of the transforming growth factor-β (TGFβ) superfamily, and of the uremic toxin indoxyl sulfate, both of which are pro-inflammatory towards endothelial cells. We hypothesized that myostatin and indoxyl sulfate may synergistically induce endothelial dysfunction by impairing endothelial proliferation and promoting a pro-inflammatory phenotype. We first investigated the effect of myostatin on cultured endothelial cells in the presence of indoxyl sulfate. We then examined the association between serum myostatin concentrations and the occurrence of cardiovascular and arteriovenous access complications in hemodialysis patients. In vitro, myostatin exhibited endotheliotoxic effects in the presence of a uremic concentration of indoxyl sulfate, enhanced its antiproliferative effect, and amplified MCP-1 and IL-8 chemokine upregulation. In patients, high myostatin concentrations correlated with indoxyl sulfate concentrations and were associated with an increased risk of arteriovenous access complications. These findings suggest that myostatin amplifies endothelial injury mediated by indolic uremic toxins and might contribute to AV access complications.

First successful use of translocated autologous great saphenous vein to the upper arm for hemodialysis access in Vietnam: A 3-year follow-up case report.

The rising global incidence of kidney failure has increased the demand for long-term hemodialysis, which requires reliable vascular access. While arteriovenous fistulas (AVFs) are typically preferred, alternative approaches are needed when autogenous options are exhausted. The use of translocated autologous saphenous vein (SV) conduits has been predominantly documented in developed countries but rarely employed in developing nations, including Vietnam. We presented the case of a 54-year-old patient with dysfunction of all common vascular access sites and central venous catheters. This case represents the first successful use of a translocated autologous great saphenous vein to create arteriovenous access in Vietnam, with a follow-up period of 3 years. The study also highlights the potential of autologous SV conduits as a superior option for vascular access compared to prosthetic grafts. This approach is particularly crucial in developing countries, where economic constraints and the high prevalence of kidney disease often limit access to prosthetic grafts.

Endovascular Thrombectomy of Arteriovenous Dialysis Access: A Feasible Treatment?

There is no single best treatment for arteriovenous vascular access thrombosis, with comparable patency rates for both surgical and endovascular treatment. This study aims to evaluate the results of endovascular thrombectomy in our center and analyze the patency rates in different groups. We retrospectively selected patients referred to our vascular access treatment unit due to arteriovenous access thrombosis from June 2017 to February 2022. All patients were submitted to endovascular manual thromboaspiration. Patient demographic data, comorbidities and clinical data were collected from medical records for further analysis. Out of the 96 patients selected, 45 (47%) had AV grafts and 51 (53%) had AV fistulas. The mean age was 74 (±15) years and 54% were males. The overall success rate of interventions was 85.4% (n = 82), while the reintervention rate stood at 59.8% (n = 49). AV grafts exhibited superior secondary patency compared to AV fistulas (92.4% vs. 78.0% and 85.3% vs. 74.1% at 6 and 12 months, respectively; p = 0.047). Forearm fistulas demonstrated enhanced primary patency (72.7% vs. 41.5% and 58.2% vs. 23.1% at 6 and 12 months, respectively; p = 0.017), better assisted primary patency (81.8% vs. 55.8% and 81.8% vs. 42.0% at 6 and 12 months, respectively; p = 0.025), and a lower reintervention rate (27.3% vs. 63.3%; p = 0.040) compared to upper arm fistulas. Endovascular manual thromboaspiration seems to be an alternative technique for salvaging thrombosed vascular accesses. Forearm fistulas had the best assisted primary patency, which consolidates the rationale of giving primacy to its construction over other options.

Pilot Study Assessing Feasibility of a Novel Vascular Access Device in a Rabbit Model

Pilot Study Assessing Feasibility of a Novel Vascular Access Device in a Rabbit Model

Utility of the BeBack re-entry catheter to treat resistant cephalic arch occlusion in a haemodialysis patient: Case report and review of the literature.

Cephalic arch stenosis is a common complication in haemodialysis patients with brachiocephalic arteriovenous fistula (AVF) that can lead to access dysfunction. For resistant lesions that fail conventional endovascular treatment, a possible salvage approach to avoid open surgery is via sharp recanalization using re-entry catheters. We describe the unprecedented use of the BeBack re-entry catheter (Bentley InnoMed GmbH), previously the GoBack catheter (Upstream Peripheral Technologies), to overcome a recalcitrant cephalic arch occlusion by sharp recanalization in a 73-year-old female with thrombosed left brachiocephalic AVF that failed revascularization using conventional catheter and wire techniques. During the procedure, there was a contained perforation subcutaneously but the BeBack catheter was manoeuvred to re-enter into the axillary and subclavian vein. This was followed by balloon angioplasty and insertion of Viabahn (Gore Medical) stent grafts across the revascularized track. Completion angiography at end of the procedure showed smooth flow through the cephalic system without subcutaneous extravasation and our patient avoided the need for open surgical bypass. No immediate postoperative complication was encountered. Although the BeBack catheter has been predominantly used in difficult-to-treat lower limb chronic total occlusions, we have shown that it is also a potential feasible salvage option for sharp recanalization in the treatment of dysfunctional arteriovenous access.

Challenges to preserve vascular access functioning after surgical correction for arteriovenous access ischemic steal in hemodialysis patients: A single-center study.

Arteriovenous access ischemic steal (AVAIS) is a rare complication that causes morbidity and threatens hemodialysis access usability in patients with end-stage kidney disease (ESKD). This study aimed to determine the incidence of AVAIS over a 15-year period and assess the access usability after surgical correction. Access operations between January 2007 and August 2022 at Helsinki University Hospital were reviewed. Demographics, clinical, duplex, and contrast examinations with brachial artery volume flows, finger pressures, and delays to surgery were evaluated. Symptom relief, complications, access closures/re-interventions, primary, secondary, and functional patencies were assessed. Endpoints were permanent cessation of access use due to complication(s), transplantation, closure, definitive occlusion, or death. Among 2914 access-related operations, the overall incidence of AVAIS was 2.2%. At the first vascular consultation 52% had ulcer(s) or gangrene(s) resulting in 28 direct closures, and 30 corrections as follows: 20 proximalization of arterial inflow (PAI), 6 flow reduction procedures, 2 distal revascularization with interval ligation (DRIL), 1 distal radial artery ligation (DRAL), and 1 venous bypass. The median time from consultation to surgery was 18 days (range: 0-348 days) for direct closures and 43 days (0-170 days) for corrective surgery. The functional patencies after correction were 60% at 1 year and 55% at 2 years; the primary patencies were 45% and 28% and secondary patencies 61% and 57%, respectively. The functional patencies after PAI were 41% and 31%, respectively. In AVAIS, access preservation is challenging in ESKD patients with multiple diseases. Attention should be paid to the original choice of vascular access by considering each patient's risks. Delay to vascular consultation and intervention should be minimized. PAI should be reserved for selected patients when no other option is preferable.

Implantable Biosensors for Vascular Diseases: Directions for the Next Generation of Active Diagnostic and Therapeutic Medical Device Technologies.

Cardiovascular disease remains the leading cause of morbidity and mortality worldwide. Key challenges such as atherosclerosis, in-stent restenosis, and maintaining arteriovenous access, pose urgent problems for effective treatments for both coronary artery disease and chronic kidney disease. The next generation of active implantables will offer innovative solutions and research opportunities to reduce the economic and human cost of disease. Current treatments rely on vascular stents or synthetic implantable grafts to treat vessels when they block such as through in-stent restenosis and haemodialysis graft failure. This is often driven by vascular cell overgrowth termed neointimal hyperplasia, often in response to inflammation and injury. The integration of biosensors into existing approved implants will bring a revolution in cardiovascular devices and into a promising new era. Biosensors that allow real-time vascular monitoring will provide early detection and warning of pathological cell growth. This will enable proactive wireless treatment outside of the traditional hospital settings. Ongoing research focuses on the development of self-reporting smart cardiovascular devices, which have shown promising results using a combination of virtual in silico modelling, bench testing, and preclinical in vivo testing. This innovative approach holds the key to a new generation of wireless data solutions and wireless powered implants to enhance patient outcomes and alleviate the burden on global healthcare budgets.

Right ventricular-pulmonary arterial coupling and pulmonary hypertension in hemodialysis: insights into structural cardiac changes and clinical implications

Objectives This cross-sectional analysis from the CZecking Heart Failure in patients with advanced Chronic Kidney Disease trial (ISRCTN18275480) examined pulmonary hypertension and right ventricular-pulmonary arterial coupling in patients on chronic hemodialysis. The aims of this analysis were: 1. To analyze relations between pulmonary hypertension and right ventricular-pulmonary arterial coupling with dialysis access flow and current hydration; 2. To analyze structural heart changes associated with right ventricular-pulmonary arterial uncoupling; 3. To reveal the prevalence, etiology and severity of pulmonary hypertension in the Czech hemodialysis population. Methods We performed expert echocardiography, vascular access flow measurements, bioimpedance analysis, and laboratory testing in 336 hemodialysis patients. Results Pulmonary hypertension was present in 34% (114/336) patients and right ventricular-pulmonary arterial uncoupling was present in 25% of patients with pulmonary hypertension. Only weak associations between the flow of the dialysis arteriovenous access and estimated pulmonary arterial systolic pressure and right ventricular-pulmonary arterial coupling was proved. There was a strong association between hydration status assessed by estimated central venous pressure with pulmonary arterial systolic pressure (Rho 0.6, p < 0.0001) and right ventricular-pulmonary arterial coupling (Rho −0.52, p < 0.0001) and association between overhydration to extracellular water ratio with pulmonary arterial systolic pressure (Rho 0.31, p = 0.0001) and right ventricular-pulmonary arterial coupling (Rho −0.29, p = 0.002). The prevalence of heart failure was significantly higher in patients with right ventricular-pulmonary arterial uncoupling (88% vs. 52%, p = 0.0003). Conclusion These findings suggest that optimizing volume status and treating heart failure should be prioritized in hemodialysis patients to prevent pulmonary hypertension progression and right ventricular-pulmonary arterial uncoupling.

The Efficacy of Ultrasound-Guided Selective Nerve Block in the Endovascular Treatment of Arteriovenous Fistulas

Introduction: Delivering requisite anesthesia for endovascular treatment of dysfunctional arteriovenous fistulas (AVFs) under a targeted nerve block can achieve reasonable analgesia. We evaluated the efficacy and safety of ultrasound-guided selective nerve block (SNB) during percutaneous transluminal angioplasty (PTA) of dysfunctional arteriovenous access. Methods: Two hundred forty-six patients with dysfunctional radiocephalic AVF undergoing PTA were enrolled in this prospective, randomized controlled trial at the Department of Nephrology, Haidian Hospital, Peking University Third Hospital from June 1, 2022, to August 31, 2023. The patients were randomized into either the SNB group (SNB group, n = 123) or the local infiltration anesthesia group (LA group, n = 123). A visual analog scale (VAS) from no pain (= 0) to worst pain possible (= 10) was used to assess the pain intensity. Patient and operator satisfaction were graded from 0 to 2: 0, not satisfied at all; 1, partially satisfied; 2, satisfied. The AVF patency at 1 and 3 months after PTA was also evaluated. Results: Compared with the LA group, the SNB group had significantly lower VAS scores (Z = −7.193, p < 0.001) and required fewer additional anesthetics during the operation (χ2 = −4.847, p = 0.028). Patient and operator satisfaction were significantly higher in the SNB group (p < 0.05). Eight patients in the SNB group encountered grade 3 motor paralysis after the operation, and they all recovered within 60 min. There was no significant difference in primary patency rates of the fistula between the two groups either at 1 month or 3 months after the operation (p > 0.05). Conclusion: Compared with LA, ultrasound-guided SNB has advantages over the LA during endovascular treatment of dysfunctional hemodialysis (HD) fistulas. It can provide safe and efficient analgesia with excellent procedural satisfaction in HD patients.

The Utility of Vascular Access Intervention via the Distal Radial Artery Approach in Hemodialysis Patients With Vascular Dysfunction.

Although case reports exist on vascular access intervention through the distal radial artery approach, there is a dearth of clinical studies reporting its safety and clinical outcomes. This study aimed to investigate the safety and long-term outcomes of vascular access intervention utilizing the distal radial artery approach. Patients who underwent forearm arteriovenous fistula vascular access intervention at our hospital were divided into two groups: The distal radial artery approach (DRA group, N = 46) and the outflow vein approach (Vein group, N = 122). Patient characteristics, procedure results (procedure success rate, contrast medium dose, fluoroscopy dose), and one-year primary patency rates were compared between the two groups. The procedure success rate was 100% in both groups. The DRA group demonstrated significantly lower contrast medium dose, fluoroscopy dose, and fluoroscopy time compared to the Vein group. No bleeding complications, arterial occlusion, or steal syndrome occurred in the DRA group. There was no significant difference in the one-year primary patency rate between the two groups. Vascular access intervention utilizing the distal radial artery approach offers benefits in reducing contrast medium and fluoroscopy dose compared to the outflow vein approach. Moreover, it demonstrates acceptable safety and patency rates.