Endovascular Management of The Failure of Maturation of Native Arterio-Venous Fistula due to Outflow Stenosis for Hemodialysis

Abstract

Background: Arteriovenous fistula (AVF) is a significant procedure for patient in need of hemodialysis. Failure of maturation due to stenosis is a challenge that needs further intervention. Endovascular treatment allows salvaging these fistulae. Aim of the work: To identify the anatomical causes of maturation failure and to assess immediate and long-term clinical effects of PTA of non-mature native (AVF) caused by outflow stenosis using currently available endovascular techniques. Material and Methods: This study was performed on forty patients complaining of stenosis of primary AVF. The mean age is 60.5. Patients were followed-up every two weeks for the first 2 months, then every month for 6 months post-intervention clinically and radiologically. Collected data includes patient's demographics, cause of renal failure, characters of primary AVF, and variables of endovascular intervention, primary patency, and recurrence of stenosis. Results: AVF type was either brachiocephalic (57.5%), brachiobasilic (32.5%) or radiocephalic (10.0%). Fistulography revealed peripheral venous stenosis in 18 patients (45.0%), central venous stenosis in 14 patients (35.0%), and juxta-anastomotic stenosis in 8 patients (20%). Our technical success was achieved in 87.5% of cases; the patency rate was 91.0% in a month, 86.0% in 3 months, and 80.0% in 6 months. Complications were reported in 10 cases. The recurrence was reported in 7 patients (17.5% of cases). Conclusions: Endovascular salvage of failing A-V fistulas with PTA and Stenting is safe and effective. It is associated with high success rates, low complication rates, and rendering the immediate reuse of the failing shunt.