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    • Evaluation of the Endovascular salvage outcome for dysfunctional arteriovenous fistula according to the site of the lesion

    Hisham Mostafa (MD)1 , Usama Lotfi (MD, MRCS)1 , Ahmed Abdulrahman (MSc) 2
    Department of Vascular Surgery, Faculty of Medicine, Cairo University, Department of Surgery, faculty of Medicine, Fayoum University

    Background: Percutaneous transluminal angioplasty (PTA) has become an established treatment of dysfunctional arteriovenous fistula (AVFs). The outcome of such intervention is significantly influenced by the site of the underlying lesion. Aim of the study: To focus on the impact of the site of the lesion(s) tackled on the immediate and delayed outcomes of endovascular salvage of dysfunctional AVFs in terms of technical success and 6 month patency rate; aiming at significant improvement in the management plan. Patients and methods: This prospective study was carried out since January 2012 through August 2015. The study included 253 hemodialysis patients; 147 (58.1%) males and 106 (41.8%) females with a mean age of 58 ± 15 years. All patients had dysfunctional native AVFs that were subjected to endovascular salvage. The outcomes were evaluated in view of the site of underlying lesions. Results: The dysfunction of the studied AVFs was caused by an underlying single lesion in 225 (88.9%) cases; while multiple lesions were found in 28 (11.1%) cases. The commonest site of lesions was encountered in the venous juxtaanastomotic segment 76 (30%) and venous needling segment 61 (24.1%). Technical success was achieved in 231 (91.3%) patients. Recanalization was best achieved through trans-radial access in 191 (75.4%) AVFs. Balloon angioplasty successfully recanalized 216 AVFs, while stenting was needed in 15 patients. No major complications have been recorded. Follow up period ranged from 6-20 (mean 8 ± 5.3) months. The overall primary patency rates were 88.3% and 71.4% at 1 and 6 months respectively. Technical success and patency rates were recorded according to site stratification. Conclusion: The site of the lesion has an impact on the outcome of endovascular salvage of dysfunctional AVF with variable immediate success and later patency rates. Arterial and central venous lesions have the least success and patency rates. However, unfavorable rates are not an invitation to regret from paying effort for salvage. Simply, because intervention can be repeated, and more importantly, the use of suitable tools and techniques can optimize the results according to each lesion site. Key words: Endovascular, arteriovenous fistula, dysfunction, salvage, site of lesion. 

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