Balloon management of Dysfunctional Arteriovenous Fistula for Hemodialysis with Ligation of Competitive Veins

Abstract

Introduction: Arteriovenous fistula (AVF) is the recommended access for patients in need for long term hemodialysis (HD). The primary dysfunction of AVF because of stenosis is a surgical problem and need to manage it. The aim of the study is to salvage AVFs by balloon angioplasty. Methods: a prospective clinical study was done from July 2019 to November 2022, including 42 dysfunctional native AVFs, and recommended for endovascular salvage. Follow up of patency of AVF along duration of the study (12 months) post-intervention using fistula-gram to estimate the success and patency rate with preserving function. Results: the study was done on 42 end stage renal disease (ESRD) patients. 42 AVFs, aged 45.6 ± 14.2 years, 27 (64.3%) were males, 15 (35.7%) were females, 3 (7.1%) patients were smokers, 33 (78.6%) of the patients were diabetics, 32 (76.2%) patients were hypertensive and 27 (64.3%) patients have ischemic heart disease. The stenotic lesions were detected in AVA in 4 (16.7%) patients, Juxtaanastomotic in 3 (12.5%) patients, Proximal venous outflow in 6 (25%), distal venous outflow in 7 (29.2%) and lesion in central venous in 2 (8.3%) patients. Success rate was recorded in 30 (71.4%) patients. Conclusion: Endovascular approach for treatment of non-functioning AVF is safe and efficient for maturation of the AVF and make it useful for hemodialysis.