Low-flow maturation failure of distal accesses: Treatment by angioplasty of forearm arteries

Abstract

When a distal access fails to mature because of forearm artery lesions, PTA should be done and will salvage the fistula without risk of distal ischemia and cardiac failure. Efficacy of PTA clearly influences surgical strategy and is a major argument in favor of attempting to create distal accesses in patients with mild distal artery lesions. Even in cases of failure, such as early occlusion of the fistula, this technique does not jeopardize further proximal access creation. Forearm access creation should be avoided only in cases of extremely severe distal artery lesions.

Juxta-anastomotic stenting with aggressive angioplasty will salvage the native radiocephalic fistula for dialysis

“…The best AVF configuration is the distal radiocephalic (RC) AVF, with the best patency and lowest reintervention rates compared with alternative access types. [1][2][3][4] Access failure from venous stenoses is the commonest problem, occurring in up to 78% of cases. 5,6 Fistulas that fail to mature (FTM) are AVFs that never develop to the point of dialysis, many of which are traditionally abandoned.…”

“…9 Conventional management strategies for JXA stenoses are all problematic. 1,2,7 Proximalization of the RC AVF is often used to treat problems in the JXA segment. However, this reduces the useable length of the fistula, and similar JXA problems often develop at the site of proximalization.…”

Endovascular treatment of dysfunctional arteriovenous fistula in hemodialyzed patients — the results of one year follow-up

“…In contrast, they did not confirm any correlation between the type of pathology (stenosis vs occlusion) and PP rates [15]. Raynaud et al observed significantly higher number of restenosis within the venous part of fistulas [24].…”

Dialysis arteriovenous fistulas: the critical role of color doppler ultrasound

“…It is mainly the result of stenosing arteriovenous lesions or of an excess of collaterals in the venous section. These causes are easily detected sonographically (33,42). Excess of superficial or perforating collaterals on the draining vein implies a rapid decrease of the fistulous venous flow and henceforth dialysis problems.…”