Surgical versus endovascular management in hemodialysıs arteriovenous fistula dysfunction: Single-center results.

AIM: Survival of patients with end-stage renal disease naturally depends on the preservation of functional vascular access. This study aims to compare 1-year patency rates, procedural success, and reintervention requirements of surgical revision with endovascular interventions in the treatment of arteriovenous fistula dysfunction.

MATERIAL AND

METHODS

Data of 1008 patients who underwent intervention due to arteriovenous fistula dysfunction between 2015 and 2022 were analyzed retrospectively. Treatment allocation to the surgical group (n = 896) or endovascular group (n = 112) was strictly dictated by objective preoperative Doppler ultrasonography criteria, primarily absolute thrombus load. To accurately reflect the operative strategy and disease severity, the surgical cohort was categorized by primary clinical pathology: thrombosis, low flow (<600 mL/min), infection, cephalic arch stenosis, and aneurysm. Endovascular interventions primarily utilized paclitaxel-coated balloons and bare metal stents. The primary endpoint was the 1-year primary patency rate; the secondary endpoint was the need for reoperation.

RESULTS

The mean age was 59.2 ± 12.7 years, and males were the majority (61%). The 1-year primary patency rate was significantly higher in the surgical group (78.6%, n = 704) than in the endovascular group (24.0%, p < 0.001). Subgroup analysis of the surgical group revealed a patency rate of 81.0% (n = 552) for thrombectomy and 97.4% (n = 39) for cephalic arch stenosis. Although the low-flow group achieved a patency rate of 79.7%, it exhibited the highest reoperation rate at 21.7%. In the endovascular group, assisted primary patency reached 78.0% with secondary procedures, while the frequency of intervention was statistically significantly higher than in the surgical group.

CONCLUSION

Surgical revision provides better patency and less re-intervention compared to endovascular methods for arteriovenous fistula dysfunction, especially in cases of high thrombus burden or cephalic arch stenosis. Single-stage open surgery guarantees long-term durability and immediate cannulation.