Ultrasound-guided angioplasty in the treatment of arterio-venous fistula stenosis

Background: stenoses in the arterio-venous fistulae (AVF) for hemodialysis are a very common problem and there is a long experience in its treatment by percutaneous angioplasty (PTA). These procedures, however, imply important needs for equipment, exposure to radiation and intravenous contrast that are not beneficial for the patient and make it more complex to perform. This study reviews our initial experience in ultrasound-guided angioplasty. Material and methods: prospective cohort of patients with native AVF dysfunction due to significant venous stenosis, undergoing a PTA ultrasound-guided. Puncture of the AVF, catheterization of the lesion, localization and inflation of the balloon and verification of the result were ultrasound-guided, with only a fistulography performed before and after the dilation. As a control-cases, patients intervened by the usual angiographic method were also collected. Results: of the 51 ATP performed on native AVF between February 2015 and September 2018, 27 were ultrasound-guided (mean age 65.3 years, 63% males). The technical success was 96%. In 26% of the cases, ATP was repeated due to residual stenosis after the angiographic image. There were 7.3% peri-procedural complications. 92% of the AVF were punctured at 24 h. Primary patency rates at 1 month, 6 months and 1 year was 100%, 64.8% and 43.6% and Assisted 100%, 87.2% and 74.8%, respectively. There were no significant differences in the immediate or late results with respect to angioplasty of AVF guided by angiography. Conclusions: ATP-FAV can be safe and effectively performed by Doppler ultrasound guidance. This method simplifies the logistics of the procedure although further improvements are needed to ensure that ultrasound is adequate to ensure the correct patency of the vessel.