A Novel Single-Needle Distal Return Strategy Achieves Sustained Dialysis Efficacy and Eliminates Reinterventions in High-Risk Arteriovenous Fistulas.

RATIONALE &

OBJECTIVE

Patients with arteriovenous fistulas (AVFs) facing recurrent interventions endure high procedural burdens and costs. We evaluated a novel single-needle distal return (SNDR) technique in refractory AVF cases to assess its impact on dialysis adequacy, reintervention rates, and economic outcomes.

STUDY

DESIGN

Single-center retrospective self-controlled study.

SETTING &

PARTICIPANTS

Twenty-five maintenance hemodialysis patients at a tertiary Chinese center (2021-2025) with AVF failure because of complete outflow occlusion (n = 6), venous hypertension (n = 8), procedural fatigue (n = 5), or inadequate cannulation length (n = 6).

FINDINGS: Over a median follow-up of 24 months, SNDR significantly improved dialysis adequacy (median single-pool Kt/V: 1.08 vs 1.46, P < 0.001) and ultrafiltration achievement ratio (72% vs 98%, P < 0.001). The annualized reintervention rate decreased by 90% (3.7 to 0.36 events/year, P < 0.001), access-related costs fell by 88% (¥135,000 to ¥16,000/year, P < 0.001), and temporary catheter use was eliminated in 88% of patients. Safety outcomes improved: dialysis machine alarms decreased from 28 to 3 per 100 sessions (P < 0.001) and hematoma rates from 8.0% to 1.5% of sessions (P < 0.001). Venous pressure remained within safe ranges (124 vs 118 mm Hg, P = 0.15).

LIMITATIONS: Single-center retrospective design and modest sample size limit generalizability.

CONCLUSIONS

The SNDR technique not only sustained but improved dialysis efficacy while substantially reducing reinterventions, costs, and complications in complex AVF failure. This approach represents a transformative salvage strategy that substantially reduces costs before resorting to catheter-dependent options.