title: Effectiveness of collateral vein embolization for salvage of immature native arteriovenous fistulas.
abstract: OBJECTIVE
  To investigate the value of collateral vein embolization (CVE) as a salvage treatment for nonmaturing native arteriovenous fistulae (AVFs) in patients requiring hemodialysis.
  
  
  METHODS
  A total of 49 patients undergoing CVE (N = 65) for immature native AVFs at a single institution were reviewed. The study included 42 patients treated by 56 embolizations. Average fistula age at time of intervention was 18.2 weeks. Each patient underwent angiographic evaluation for fistula immaturity, with clinical success defined by initiation of single-session hemodialysis through the native fistula.
  
  
  RESULTS
  Fistula maturity was achieved in 32 of 42 patients (76.2%). No major complications occurred. Average time from CVE to fistula maturity was 38.4 days. Angioplasty done with CVE was found in a statistically higher percentage of patients with fistula success versus failure (31.3% vs 8.3%; P = .039). Radiocephalic fistulae were seen in a higher percentage of fistula failures compared with successes, but the results were not statistically significant (83.3% vs 59.4%; P = .054). Thirty-four patients underwent CVE without angioplasty, which resulted in successful fistula maturation in 22 cases (64.7%). Radiocephalic fistulae were again seen in a higher percentage of fistula failures compared with successes, but the findings did not meet statistical significance (81.8% vs 54.5%; P = .052).
  
  
  CONCLUSIONS
  Coil embolization of competing collateral vessels as a salvage treatment for nonfunctioning autologous AVFs is a viable treatment option in the majority of patients. Patients with radiocephalic fistulae may be at higher risk for primary fistula failure, but the present data are inconclusive.
authors.affiliation: Department of Radiology, University of Chicago Medicine, 5841 S. Maryland Ave., MC 2026, Chicago, IL 60636. Electronic address: osman1423@gmail.com.
authors.forename: Osman
authors.initials: O
authors.lastname: Ahmed
authors.affiliation: Department of Radiology, University of Chicago Medicine, 5841 S. Maryland Ave., MC 2026, Chicago, IL 60636.
authors.forename: Mikin
authors.initials: M
authors.lastname: Patel
authors.affiliation: Department of Radiology, University of Chicago Medicine, 5841 S. Maryland Ave., MC 2026, Chicago, IL 60636.
authors.forename: Michael
authors.initials: M
authors.lastname: Ginsburg
authors.affiliation: Wright State University Boonshoft School of Medicine, Dayton, Ohio.
authors.forename: Danial
authors.initials: D
authors.lastname: Jilani
authors.affiliation: Department of Radiology, University of Chicago Medicine, 5841 S. Maryland Ave., MC 2026, Chicago, IL 60636.
authors.forename: Brian
authors.initials: B
authors.lastname: Funaki
mesh_terms: D015901:Angiography, Digital Subtraction / Q000379:methods; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000628:therapy*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome