Endovascular Management of Failing Vascular Access for Haemodialysis

Abstract

Summary and Conclusion E ndovascular evaluation coupled with angioplasty of vascular stenotic lesions results in high salvage rates of “failing to mature” fistulas. The locations of the vascular lesions which prevent the maturation of the AVF were as follows: In the artery, arterial anastomosis, juxta-arterial anastomosis, peripheral vein, and central vein. The most common lesion is stenosis of the juxta-arterial anastomosis segment. The juxta-arterial anastomosis lesion significantly restricts the flow to the AVF, prevents the maturation process, and may progress to complete occlusion if untreated. Endovascular treatment of the “failing to mature AVF” does not eliminate the need for additional vascular surgery in some patients. However, endovascular treatment should be attempted before surgery is considered for the following reasons: 1. Endovascular treatment is associated with excellent success rates, low complication rates, and promising long-term patency rates. Most important, this is done without the introduction and assistance of synthetic polytetrafluroethylene grafts. 2. Because vein manipulation is incriminated in juxta-arterial anastomosis stenosis, avoidance of surgery, if possible, eliminates the risk for recurrent stenosis at sites of new arterial and juxta-arterial anastomosis. 3. During endovascular treatment, AVF mapping is an inherent part of the procedure. This uncovers all of the contributing lesions to AVF dysfunction. Such information is valuable and is the basis for any successful treatment approach. This increases the chances of successful surgical revision. In other instances, it may mean totally abandoning the existing AVF and saving the patient from unnecessary surgical revision. Conclusion Endovascular treatment of “failing to mature AVF” is both safe and effective. When it is performed in a dedicated access center, it is associated with high success rates, low complication rates, and promising AVF primary and secondary patency rates.