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Forearm Arteriovenous Fistula Maturation Delay due to Juxta-Anastomotic Stenosis: Role of Percutaneous Angioplasty

Introduction: Arteriovenous fistula is the optimal vascular access for hemodialysis as it has the best long-term patency rate and the lowest complication rate. Although we are still lacking consensus, surgery has been advocated as the best treatment option for maturation delay. We proposed to evaluate the results of endovascular approach of arteriovenous fistula’s maturation delay in our hospital. Methods: We conducted a retrospective study, selecting patients referred to our diagnostic and therapeutic angiography unit due to arteriovenous fistula delayed maturation, between April 2017 and June 2020. Results: Thirty-four patients were referred to our center due to maturation delay, of which six (17.7%) were excluded as the diagnosis was not confirmed and six (17.7%) because the lesions were not suitable for percutaneous angioplasty. The other 22 patients (64.7%) were subjected to percutaneous endovascular treatment. Mean age was 67.3 ± 13.8 years. Eighteen patients (81.8%) had maturation delay due to peri-anastomotic stenosis; 12 (66.7%) were forearm fistulas (all radio-cephalic). Mean follow-up time was 21.2 ± 11.2 months. Eleven (91.7%) fistulas were salvaged, although four (33.3%) needed reintervention. Primary and assisted primary patencies at 6 and 12 months were 66.7% vs 91.7% and 58.3% vs 91.7%, respectively. Conclusion: Our results point out that endovascular treatment is a good treatment option for maturation delay of forearm arteriovenous fistulas due to juxta-anastomotic stenosis. Even though surgical treatment appears to have better primary patency, a step-by-step approach seems to be a valid strategy, as our assisted primary patency shows.