Endovascular treatment of dysfunctional arteriovenous fistula in hemodialyzed patients — the results of one year follow-up

Introduction. The arteriovenous fistula (AVF) dysfunction is a common reason for vascular access problem in chronically hemodialyzed patients. It is caused by stenosis or occlusion located either in inflow artery, anastomosis or outflow vein. Revascularization of these pathologies can be achieved in surgical or endovascular (PTA) manner. The aim of this study was to evaluate both immediate and late endovascular treatment results of dysfunctional fistulas in chronically hemodialyzed patients. Material and methods. We included in our observation 106 patients with end stage renal disease, who un-derwent PTA within arteriovenous fistulas. We used conventional and unified techniques of endovascular therapy. Procedural results were evaluated after 1, 3, 6 and 12 months based on fistula sufficiency during hemodialysis. Results. In 96 (90.6%) cases the initial result of PTA was good. We achieved improvement in blood flow through AVF and successful hemodialysis. In 10 cases (9.4%) results were not satisfactory. None of our patients developed neither worsening in the blood flow through AVF nor compromised blood circulation distally to AVF. No serious complications (MI, stroke, death) occurred during procedure or hospital stay. After 12 months, in 52 patients AVF were functioning properly. In 20 cases, because of fistula dysfunction, reintervention was necessary (primary patency 66%). Considering all patients, also these with successful reintervention, 69 AVF were functioning properly after 12 months (secondary patency 86%). Conclusions. To conclude, the immediate and long-term PTA outcomes of arteriovenous fistulas with currently available techniques and equipment are satisfying. PTA is a safe manner of prolonging patency rate of AVF in patients requiring permanent hemodialysis.