One-year patency rate of native arteriovenous fistulas reconstructed by vascular stripping in hemodialysis patients with venous neointimal hyperplasia.

OBJECTIVE

There are limited therapeutic measures for stenosis of arteriovenous fistulas (AVFs) due to venous neointimal hyperplasia (VNH). In the current retrospective study, we reviewed the clinical data of hemodialysis patients who underwent AVF reconstruction by VNH stripping. The primary measure of interest was the secondary patency rate of the restored AVF.

METHODS

The study included hemodialysis patients who underwent AVF reconstruction by VNH stripping (group A), AVF reconstruction proximal to the original fistula (group B), or creation of a new AVF (group C). Patency was evaluated immediately after the surgery and at follow-up visits.

RESULTS

Of 353 patients who underwent AVF reconstructions, 327 (91.9%) were for late AVF failure. The final analysis included 305 patients: 76, 128, and 101 patients in groups A, B, and C, respectively. The three groups were comparable in age, sex, causes for AVF, AVF sites, and the artery for the AVF (P > .05). At 3-month follow-up, the secondary AVF patency rate was comparable across the three groups at 93.4%, 92.2%, and 92.1% in groups A, B, and C, respectively. The patency rate at 6 and 12 months was also comparable across groups A, B, and C at 89.5%, 89.8%, and 88.1% at 6 months and 84.2%, 85.9%, and 81.2% at 12 months, respectively.

CONCLUSIONS

Reconstructing the AVF by surgically removing VNH is an effective technique for late hemodialysis access failure, with maximal preservation of blood vessels.