Outcomes of Salvage Procedures for Occluded Autogenous Radiocephalic Arteriovenous Fistula

Abstract

The outcomes of surgical and endovascular treatments for thrombosed access fistulas are variable and provide no definitive indications for treatment choice. We purposed to review our experience in treating thrombosed radiocephalic arteriovenous fistulas (AVFs) and to evaluate the outcome of procedures, including proximal neoanastomosis (NEO), replacement of the stenosed segment with a polytetrafluoroethylene graft (GI), patch angioplasty (PA), and endovascular procedures (such as percutaneous transluminal angioplasty [PTA]). A total of 117 occluded radiocephalic AVFs were treated by surgery or an endovascular procedure from January 2002 to December 2007. We evaluated the rates of initial success, re-thrombosis, the post-interventional five-year patency rate, and temporary catheter requirement. Forty-five patients (38.5%) underwent NEO, 32 patients (27.4%) GI, 10 patients (8.5%) PA, and 30 patients (25.6%) PTA. The overall initial procedural success rate was 98.3% (surgery 98.9% and PTA 96.7%), and the post-interventional patency rates at five years were 92.2% (97.1% for NEO, 82.7% for GI, 90.0% for PA, and 96.7% for PTA). Twenty-four patients (20.5%) required a temporary catheter during healing of the functioning segment after treatment: four patients for NEO, 18 patients for GI, two patients for PA, and no patients for PTA (P < 0.001). Both surgery and endovascular treatment gave high rates of initial success and low re-thrombosis rates as salvage treatments for occlusion of radiocephalic AVFs, if treatments were selected according to the length, and location of the stenosis to be corrected. When stenosis of a long segment is suspected, endovascular treatment should be attempted first in order to maintain the functional segment and thereby avoid use of a temporary catheter.