Endovascular Salvage of Immature Autogenous Hemodialysis Fistulas

To report the technical success and long-term clinical outcomes of immature arteriovenous fistula (AVF) after percutaneous angioplasty (PTA).

Patients with 58 immature AVF underwent PTA treatment in our institute during the past 9 years. Based on pretreatment ultrasound findings, the immature AVFs were categorized as stenosed, thrombosed, and obliterated type. An optimal entry site was punctured under ultrasound guidance followed by conventional fluoroscopy-guided PTA technique. Technical and clinical success as well as complications were recorded. Patency after angioplasty was estimated using Kaplan–Meier analysis. Predictors of patency were estimated using log-rank test.

In our series, 50 % (29 of 58), 20.7 % (12 of 58), and 29.3 % (17 of 58) of immature AVF were stenosed, thrombosed, and obliterated, respectively. Technical and clinical success was achieved in 96.6 % (56 of 58) of cases with 100 % success in both the stenosed and thrombosed lesions and 88.2 % (15 of 17) success in the obliterated lesions. Vascular ruptures occurred in 12.1 % (7 of 58) of lesions. The overall primary and secondary patency rates of the 58 lesions were 45.4 and 84.2 % at 12 months and 36.5 and 80.1 % at 36 months. There were no significant differences of patency between the three types of lesions (p = 0.075 and 0.093) and the two groups of patients with or without residual side branches after intervention (p = 0.527 and 0.644). There was a significant difference of primary patency in patients with vascular rupture (p = 0.012) with a hazard ratio of 3.236.

PTA could effectively prolong the lifetime of immature AVFs with high technical success. Vessel rupture was predictive of shorter primary patency, and long-term secondary patency was acceptable.