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Role of endovascular treatment in dysfunctional hemodialysis fistulae: A single center experience
Vishal Thakker1, Prashant Sarda1, Vivek Ruhela2, Manali Arora1, Rohit Sharma1, Rajiv Kumar Azad1
1 Department of Radio-Diagnosis, SGRRIM&HS, Dehradun, Uttarakhand, India
2 Department of Nephrology, SGRRIM&HS, Dehradun, Uttarakhand, India
Correspondence Address:
Manali Arora,
Department of Radio-Diagnosis, SGRRIM&HS, Dehradun, Uttarakhand
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/ijn.ijn_444_21
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Introduction: Arteriovenous fistulas (AVFs) are the preferred route of hemodialysis in end-stage renal disease. However, recurrent patency loss is an obstacle in long-term maintenance. Endovascular treatments may provide a durable option for prolongation of patency in AVFs. Methods: Retrospective observational study was done on 46 patients with AVF for hemodialysis in the Department of Diagnostic and Interventional Radiology for a period of 1 year from September 2020 to August 2021. The characters of dysfunctional fistulas and results of various interventional procedures were assessed for technical and clinical success rates. Short-term follow-up records of patients were assessed for post-intervention primary patency (PIPP) and post-intervention assisted primary patency (PIAPP) of various procedures. Results: The most successful outcomes post intervention were seen in radio-cephalic fistulas formed more than 1 year ago with juxta-anastomotic narrowing. The overall technical success rate was 89.13% with a PIPP of 78.26% and a PIAPP of 82.60% at 3 months. PTA had better technical success rates (88.23%) as compared to dysfunctional segments with thrombosis that underwent angioplasty and thromboaspiration (84.2%). Central venous stenosis undergoing PTA and stenting had a 100% success rate. At 3 months follow-up, PIPP was better among the angioplasty plus thromboaspiration group (73.7%), while PIAPP rate was better in the angioplasty subgroup at 82.35%. Conclusion: Endovascular intervention is the first-line treatment in dysfunctional AVFs attributable to the multitude of options available, all of which have comparable outcomes, high success rates, and notable short-term patency.
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