Endovascular management of peri-anastomotic venous stenosis in renal dialysis arterio-venous fistula

Endovascular treatment of the malfunctioning fistula can involve a combination of angioplasty, stenting and the use of thrombolysis with low reported mortality and morbidity. The primary aim of the study was to determine the primary patency and primary assisted patency rates of angioplasty for the treatment of perianastomotic stenosis of renal dialysis arterio-venous fistulas (AVFs). The secondary purposes were to identify the factors that may impact restenosis rate and to evaluate the need for close surveillance of AVF. This is a retrospective analysis of AVF angioplasty for peri-anastomotic stenosis. Between August 2009 and March 2012, 44 patients with autologous AVF were treated with percutaneous transluminal angioplasty (PTA). The technical success rate was 100%. 23 of the 44 patients (52.3%) required repeated intervention during the follow-up period. Our primary patency rate at 1 year was 62.5% and the primary assisted patency rate was 96.9% at 1 year. No immediate post-procedure complications.ConclusionEndovascular management of peri-anastomotic stenosis in renal dialysis AVF is an effective approach with low morbidity and mortality rates. The higher primary assisted patency compared to the primary patency rate emphasizes the need for close surveillance of AVF and low threshold for early re-intervention.