Endovascular Treatment of Failing Arterio-Venous Fistula for Hemodialysis

Abstract

Khalid Abdo El Hendawy, Usama Ali Lotfi, Mostafa Mahmoud Hussein, Mahmoud Eldesouky, Moamen Mostafa Nagi*

Background: Percutaneous trans-luminal angioplasty has become an established treatment of dysfunctional arterio-venous fistula. The outcome of such intervention is significantly influenced by the site of the lesion. Aim of the study: To analyze the impact of the site of the treated lesion(s) on the immediate and delayed outcomes of endovascular salvage of dysfunctional AVFs in terms of technical success and 3, 6 months patency rates. Patients and methods: This study was carried out from February 2016 to February 2018. It included 60 hemodialysis patients who had dysfunctional native AVFs that were subjected to endovascular salvage. Results: AVFs dysfunction was caused by an underlying single lesion in 50 cases while multiple lesions were found in 10 cases. The commonest site of occlusion was central veins (23.3%) while the least common site was the proximal arterial segment (1.7%). Technical success achieved in 88.3% patients. Recanalization was best achieved through trans- radial in the majority of cases. Balloon angioplasty alone successfully re-canalized 41 AVFs, while stenting was needed in 8 patients and 4 cases aided by thrombectomy. Of them 3 AVFs only were abandoned on top of procedure complications. The overall primary patency rates of 50 AVFs were 82% and 58% at 3 and 6 months respectively. Conclusion: PTA is simple, less invasive, shorter procedure, enables immediate dialysis without the need for CVC, reduces the risk of infection, and saves the patient’s veins. The site of the lesion has an impact on the outcome of endovascular salvage of dysfunctional AVF with variable immediate success and later patency rates.