title: Nonmaturing Fistulae: Epidemiology, Possible Interventions, and Outcomes.
abstract: Autogenous arteriovenous fistulae are the best method for prolonged, successful dialysis access. However, a substantial limitation of dialysis fistulae is their high primary failure rate, estimated to be as high as 70% for radiocephalic fistulae. Fistula maturation is influenced by demographic risk factors as well as anatomical barriers, the latter of which can be readily identified by noninvasive ultrasound imaging and physical examination. These barriers can be categorized as inflow problems (native arterial disease, arteriovenous anastomotic stenosis, and juxta-anastomotic stenosis) or outflow problems (proximal venous stenosis or collateral veins). Venous stenoses represent the most commonly observed barrier to fistula maturation. By treating these barriers with a systematic approach, interventionalists can significantly improve the likelihood of a fistula's usability for dialysis.
authors.affiliation: Department of Interventional Radiology, MD Anderson Cancer Center, Houston, TX. Electronic address: rasheth@mdanderson.org.
authors.forename: Rahul A
authors.initials: RA
authors.lastname: Sheth
authors.affiliation: Division of Vascular and Interventional Radiology, Department of Diagnostic Imaging, Kaiser Permanente, Sacramento, CA.
authors.forename: Robert
authors.initials: R
authors.lastname: Freed
authors.affiliation: Division of Vascular Interventional Radiology, Department of Radiology, Case Western Reserve University School of Medicine, Cleveland, OH.
authors.forename: Sidhartha
authors.initials: S
authors.lastname: Tavri
authors.affiliation: Department of Interventional Radiology, MD Anderson Cancer Center, Houston, TX; Department of Thoracic and Cardiovascular Surgery, MD Anderson Cancer Center, Houston TX.
authors.forename: Tam T T
authors.initials: TT
authors.lastname: Huynh
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA.
authors.forename: Zubin
authors.initials: Z
authors.lastname: Irani
mesh_terms: D000792:Angiography; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001783:Blood Flow Velocity; D003097:Collateral Circulation; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D011237:Predictive Value of Tests; D015641:Radiography, Interventional; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012307:Risk Factors; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: arteriovenous fistula; dialysis; dialysis interventions