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Corresponding Author

Bakr Mahmoud El-Ashry, Amr

Document Type

Original Article

Abstract

Abstract Background: Arteriovenous fistula (AVF) is a significant procedure for patient in need of hemodialysis. Failure of maturation due to stenosis is a challenge that needs further intervention. Endovascular treatment allows salvaging these fistulae. Aim of the work: To identify the anatomical causes of maturation failure and to assess immediate and long-term clinical effects of PTA of non-mature native (AVF) caused by outflow stenosis using currently available endovascular techniques. Materials and Methods: This study was performed on forty patient complaining of stenosis of primary AVF. The mean age is 60.5. Patient were followed-up every two weeks for the first 2 months, then every month for 6 months post-intervention clinically and radiologically. Collected data includes patient's demographics, cause of renal failure, characters of primary AVF, variables of endovascular intervention, primary patency, and recurrence of stenosis. Results: AVF type was either brachiocephalic (57.5%), brachiobasilic (32.5%) or radiocephalic (10.0%). Fistulography revealed peripheral venous stenosis in 18 patient (45.0%), central venous stenosis in 14 patient (35.0%) , and juxta-anastomotic stenosis in 8 patient (20%). Our technical success was achieved in 87.5% of cases; the patency rate was 91.0% in a month , 86.0% in 3 months , and 80.0% in 6 months. Complications were reported in 10 cases. The recurrence was reported in 7 patient (17.5% of cases). Conclusion: Endovascular salvage of failing A-V fistulas with PTA and Stenting is safe and effective. It is associated with high success rates, low complication rates, and rendering the immediate reuse of the failing shunt.

Keywords

Arteriovenous fistula; endovascular; Hemodialysis; Non-maturation; Outflow stenosis

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