Indian heart journal · 2026
Endovascular Salvage of Dysfunctional Native Haemodialysis Arteriovenous Fistulas: Clinical Outcomes and Predictors of Patency.
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Hegde Srinidhi S, Lohitashwa S B, Mullusoge Mariappa Harsha, Varghese Kiron, Srilakshmi M A, Banotra Pankaj
Аннотация
BACKGROUND: Hypofunctioning haemodialysis arteriovenous fistulas are an important cause of inadequate dialysis, access failure and morbidity in patients with chronic kidney disease (CKD), and timely catheter-based intervention may help restore access function and prolong fistula usability.
OBJECTIVES: To evaluate the efficacy, feasibility, and safety of catheter-based interventional procedures for hypofunctioning haemodialysis fistulas in patients with CKD.
METHODS: This single-centre, retrospective observational follow up study, enrolled with 100 CKD patients on maintenance haemodialysis with dysfunctional native arteriovenous fistulas who underwent fistulogram and catheter-based intervention.
RESULTS: The mean age was 57.2 ± 12.4 years, 62.0% were male, and hypertension (80.0%) and diabetes mellitus (57.0%) were the major comorbidities. Radio cephalic fistula was the commonest access type (46.0%), and inadequate dialysis was the leading presentation (73.0%). Fistulography showed significant stenosis in 96.0%, with central vein involvement in 43.0% and long-segment lesions in 56.0%. Angioplasty was attempted in 96.0%, achieving technical success in 91.7% of attempted interventions and clinical success in 85.0%. Stenosis and pressure gradient reduced significantly after intervention (both p<0.001). Complications occurred in 13.0%, with no deaths. Primary patency declined from 82.0% at 1 month to 58.0% at 6 months and 38.0% at 12 months. Patency loss was independently predicted by older age, central vein lesions, long lesions, residual stenosis, and absent post-procedure thrill.
CONCLUSION: Catheter-based endovascular intervention may be an effective fistula-salvage strategy for hypofunctioning haemodialysis arteriovenous fistulas, although long-term patency was influenced by lesion complexity, residual stenosis and restoration of post-procedure thrill.
OBJECTIVES: To evaluate the efficacy, feasibility, and safety of catheter-based interventional procedures for hypofunctioning haemodialysis fistulas in patients with CKD.
METHODS: This single-centre, retrospective observational follow up study, enrolled with 100 CKD patients on maintenance haemodialysis with dysfunctional native arteriovenous fistulas who underwent fistulogram and catheter-based intervention.
RESULTS: The mean age was 57.2 ± 12.4 years, 62.0% were male, and hypertension (80.0%) and diabetes mellitus (57.0%) were the major comorbidities. Radio cephalic fistula was the commonest access type (46.0%), and inadequate dialysis was the leading presentation (73.0%). Fistulography showed significant stenosis in 96.0%, with central vein involvement in 43.0% and long-segment lesions in 56.0%. Angioplasty was attempted in 96.0%, achieving technical success in 91.7% of attempted interventions and clinical success in 85.0%. Stenosis and pressure gradient reduced significantly after intervention (both p<0.001). Complications occurred in 13.0%, with no deaths. Primary patency declined from 82.0% at 1 month to 58.0% at 6 months and 38.0% at 12 months. Patency loss was independently predicted by older age, central vein lesions, long lesions, residual stenosis, and absent post-procedure thrill.
CONCLUSION: Catheter-based endovascular intervention may be an effective fistula-salvage strategy for hypofunctioning haemodialysis arteriovenous fistulas, although long-term patency was influenced by lesion complexity, residual stenosis and restoration of post-procedure thrill.