Juxta-anastomotic stenosis in the forearm native arteriovenous fistula: Open surgery or angioplasty?

BACKGROUND

The juxta-anastomotic stenosis (JAS) represents the major complication of arteriovenous fistula (AVF) during the first months after the surgery and the approach to JAS can be surgical or radiological.

METHODS

From 01/02/2016 to 31/12/2020, a total of 976 radiocephalic fistulas have been performed. The 15.9% of AVF was malfunctioned due to JAS. A retrospective analysis was conducted on 156 patients with JAS, in order to compare the primary outcome of surgery and percutaneous angioplasty (PTA) in JAS treatment, in the lower forearm in a follow-up of 24 months.

RESULTS

Ninety patients underwent to surgery and 66 to PTA, mean age was 63.43 ± 14.54 and 65.10 ± 15.10 years, respectively. Frequencies of diabetes mellitus and arterial hypertension were similar by groups. Cardiovascular disease was present in 20% of the surgery patients and in 42.4% PTA patients (p = 0.04). The primary assisted patency was 84.4% and 71.1% in the surgery group at 12 and 24 months and 54.5% and 69.6% in the PTA group. The secondary patency at 24 months was 95.6% for surgery group and 96.9% for PTA group, without a statistical significance. During the study period, 10 AVFs (11.1%) showed a restenosis in the surgical group and 14 (21.2%) in the PTA group.

CONCLUSIONS

This retrospective study suggests a higher restenosis rate after PTA than surgery. However, the statistical analysis shows that the failure rate of the two procedures is comparable. A dedicated multidisciplinary team could represent the goal for a good clinical practice in the treatment of JAS.