Impaired maturation of arteriovenous fistula for haemodialysis due to forearm artery stenosis: percutaneous endovascular treatment

Introduction: Distal autogenous arteriovenous fistula (dAVF), considered the "gold standard" vascular access for haemodialysis, suffers from a high rate of impaired maturation. One of the usual causes is low-flow associated forearm arterial stenosis. In such cases, endovascular treatment by percutaneous transluminal angioplasty represents a helpful option to enable maturation of the vascular access. Currently, there are few reports concerning the treatment of this complication. Therefore, we describe our single-centre experience based on a retrospective review of prospectively collected data. Patients and methods: We treated 18 consecutive patients from July 2007 to January 2014 (16 radio-cephalic, 2 ulno-basilic distal AVF). A low flow due to forearm artery stenosis was diagnosed by duplex examination, as routinely performed one month after dAVF creation. An anterograde trans-brachial access was used for a 4-mm high-pressure angioplasty of the stenosed artery. Results: All interventions resulted in patent fistulas. Isolated percutaneous transluminal angioplasty (PTA) was required without need of stent placement. Mean blood flow increased from 304 mL/min, preoperatively, to 671 mL/min (p<0.01), as checked one week after the procedure. One-year primary and secondary patency were 84% +/- 7.3% and 92% +/- 9.2%, respectively. Under no circumstances did access-induced distal ischemia occurred during follow-up. Conclusions: Endovascular approach is a helpful and minimally invasive procedure for treatment of delayed maturation of dAVF related to forearm artery stenosis.