03:09 PM Abstract No. 354 Treatment of Non-Maturing Fistula for Hemodialysis Access Via Transradial Approach: a Case-Control Study

Percutaneous salvage of nonmaturing hemodialysis fistulas remains challenging. We retrospectively compared a strategy of single transradial access for both diagnosis and intervention with our current protocol of brachial artery access for angiography followed by uni/bidirectional fistula access for intervention. IRB-approved review of immature fistulas intervened between 2015-2018. Multiple interventionalists performed 27 transradial access procedures in 26 patients compared to a contemporaneous control group of 30 procedures in 29 patients. Records were analyzed for procedure time, no. of punctures, treatment success, time to cannulation, primary unassisted/assisted patency and complications. Treated fistula types are shown in Table 1. 96%(26/27) and 83%(25/30) of interventions in the transradial and control groups were initially successful, respectively (P=0.11). Fewer direct punctures to the access were required in the transradial group compared to the control group (mean punctures per procedure 0.26 vs 1.2, P<0.001). A significant reduction in procedure time was seen in the transradial group (67 vs. 97 min, P<0.001). Time from intervention to cannulation trended toward a shorter interval in the transradial group (49 vs. 73 days, P=0.15). Post-intervention primary unassisted and assisted 6-month patency were similar in both groups (62 vs 49% and 88 vs 81% transradial vs control, respectively, P=0.12 and 0.18). Both groups had only minor complications which occurred in similar incidences. Treatment of non-maturing fistulas via transradial approach was associated with similar rates of an immediate successful outcome and decreased procedure time with fewer direct fistula accesses compared to a conventional access strategy. This study suggests that transradial access may be utilized as an alternative approach and further studies are warranted to determine the best percutaneous approach.Table 1TypeTransradial (pct)Contemporary (pct)Radiocephalic18(67)16(53)Single stage basilic1(4)2(7)Basilic vein transposition5(19)5(17)Brachiocephalic3(11)7(23) Open table in a new tab