Aggressive approach to salvage non-maturing arteriovenous fistulae: a retrospective study with follow-up.
OBJECTIVE
To establish a standardized approach for the maturation of non-maturing arteriovenous fistulae.


METHODS
Consecutive patients (n=122) with non-maturing fistulae presented to our outpatient vascular access center for percutaneous interventions to assist in maturation. The techniques used included flow rerouting, competing branch vein elimination, staged balloon angioplasty, and limited controlled extravasation.


RESULTS
Successful fistula maturations were achieved in 118/122 patients. Fistulae were divided into two classes according to initial vessel size: class 1 (6.0-8.0 mm diameter, >6 mm deep) and class 2 (2.0-5.0 mm diameter) fistulae were evaluated for differences in technical procedures and clinically successful fistula maturation. Class 1 and class 2 fistulae were evaluated for mean number of procedures to maturation (1.6 and 2.6, respectively), and time to maturation (5 and 7 weeks, respectively). Follow-up for 109 of the initial 118 patients was achieved (mean=24 months, range=0.25-60 months). Class 1 and class 2 fistulae had primary patencies of 17 and 39% at 6 months; and secondary patencies of 72 and 77% at 12 months, 53 and 61% at 24 months, and 42 and 32% at 36 months, respectively. Primary and secondary patencies (Mann-Whitney test, p=0.44 and p=0.38, respectively) of class 1 and class 2 fistulae did not differ significantly, and secondary patencies were comparable to other fistula salvage studies.


CONCLUSIONS
Fistula salvage attempts should not be limited by factors such as a diffusely small diameter or an inaccessibly deep position.
Miller
Gregg A
GA
American Access Care of Brooklyn, Brooklyn, New York, USA. vascular1@att.net
Goel
Naveen
N
Khariton
Aleksandr
A
Friedman
Alexander
A
Savransky
Yevgeny
Y
Trusov
Ilya
I
Jotwani
Kiran
K
Savransky
Eric
E
Preddie
Dean
D
Arnold
William Perry
WP
D000800:Angioplasty, Balloon / Q000009:adverse effects; D001166:Arteriovenous Shunt, Surgical; D003251:Constriction, Pathologic; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D012039:Regional Blood Flow; D012189:Retrospective Studies; D016879:Salvage Therapy; D013997:Time Factors; D017211:Treatment Failure; D014463:Ultrasonography; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency