Role of Percutaneous Endovascular Interventions in the Treatment of Failed Hemodialysis Fistula

Abstract

Background: Arteriovenous fistula is the preferred vascular access for patients requiring long-term hemodialysis because of its superior patency and lower complication rates. However, AVF (Arteriovenous Fistula) dysfunction caused by venous stenosis and thrombosis remains a major cause of access failure, compromising dialysis adequacy. PTA (Percutaneous Transluminal Angioplasty) has emerged as the first-line minimally invasive treatment for restoring fistula patency and prolonging vascular access survival. This study evaluated the procedural efficacy, safety, and short-term clinical outcomes of percutaneous endovascular intervention in failed hemodialysis fistulas.

Methods: A prospective longitudinal observational study was conducted in the Department of Radiodiagnosis, Government Medical College, Kozhikode, from June 2021 to June 2022. Forty patients with dysfunctional AVFs due to outflow vein stenosis who underwent percutaneous angioplasty were included. Clinical examination, Doppler ultrasonography, and angiographic findings were used for diagnosis and procedural planning. Balloon angioplasty was performed through arterial or venous access depending on lesion characteristics. Immediate technical success was defined by restoration of blood flow, successful recanalization, and reappearance of thrill, while clinical success was assessed by adequate dialysis flow and absence of restenosis during a 3-month follow-up. Statistical analysis was performed using SPSS version 22, with p<0.05 considered statistically significant.

Results: Among the 40 patients, radiocephalic fistulas constituted 62.5%, and combined fistula and outflow vein stenosis was observed in 97.5% of cases. Long-segment stenosis (90%) and total occlusion (85%) were the predominant lesions. Venous access was used in 75% of procedures, while fistuloplasty with venoplasty was performed in 97.5% of patients. Immediate technical success was achieved in 38 patients (95%), with only two technical failures due to inability to negotiate extensive thrombotic lesions. Minor access-site hematoma occurred in 5% of patients, with no major procedure-related complications. At 3-month follow-up, 36 of the 38 successfully treated patients (94.7%) maintained fistula patency, whereas two patients developed restenosis requiring repeat angioplasty. None of the demographic, clinical, or fistula-related variables demonstrated a statistically significant association with procedural or follow-up outcomes.

Conclusion: Percutaneous transluminal angioplasty is a safe, effective, and minimally invasive treatment for failed hemodialysis AVFs, providing a high immediate technical success rate (95%) and excellent short-term clinical patency with minimal complications. It should be considered the preferred first-line intervention for AVF dysfunction due to stenosis or thrombosis, helping preserve vascular access and improve dialysis outcomes.