title: Juxta-anastomotic stenting with aggressive angioplasty will salvage the native radiocephalic fistula for dialysis.
abstract: OBJECTIVE
  This study describes our technique of aggressive angioplasty with juxta-anastomotic stenting (JXAS) in the autogenous arteriovenous fistula and reviews our outcomes with this technique in its mature form.
  
  
  METHODS
  We developed a JXAS technique during the last 7 years. Since 2006, we have placed 135 JXASs. The study period reviews 68 consecutive JXASs placed from 2008 to 2012 using the mature technique. We retrospectively analyzed the prospectively collected data. Thirty-three fistulas received JXAS for failure to mature, and 35 were mature but inadequately dialyzing fistulas (problem fistulas). The JXAS technique involves (1) treating the JXA segment as a unit, (2) aggressive angioplasty with rupture of stenoses, and (3) placement of an uncovered nitinol stent.
  
  
  RESULTS
  Technical success was 97%. Of the fistulas that had failed to mature, 75% were brought to maturity by 6 months and 88% by 12 months. Adequate dialysis was achieved in all 35 problem fistulas immediately postoperatively. Assisted fistula patency was 90% at 2 years and 80% at 4 years.
  
  
  CONCLUSIONS
  JXAS is an effective technique for maturing and maintaining the wrist radiocephalic arteriovenous fistula.
authors.affiliation: Vascular Surgery, Westmead Hospital, University of Sydney Medical School, Sydney, New South Wales, Australia. Electronic address: john_swinnen@bluebottle.com.
authors.forename: John
authors.initials: J
authors.lastname: Swinnen
authors.affiliation: Vascular Surgery, Westmead Hospital, University of Sydney Medical School, Sydney, New South Wales, Australia.
authors.forename: Kia
authors.initials: K
authors.lastname: Lean Tan
authors.affiliation: Vascular Surgery, Westmead Hospital, University of Sydney Medical School, Sydney, New South Wales, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Allen
authors.affiliation: Department of Cardiology, Blacktown Hospital, University of Sydney Medical School, Sydney, New South Wales, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Burgess
authors.affiliation: Vascular Surgery, Westmead Hospital, University of Sydney Medical School, Sydney, New South Wales, Australia.
authors.forename: Irwin V
authors.initials: IV
authors.lastname: Mohan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D000800:Angioplasty, Balloon / Q000295:instrumentation*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000379:methods; D003251:Constriction, Pathologic; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D017534:Radial Artery / Q000503:physiopathology / Q000601:surgery*; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014680:Veins / Q000503:physiopathology / Q000601:surgery*; D014953:Wrist / Q000098:blood supply*; D055815:Young Adult
chemical_list: D000497:Alloys; C013616:nitinol