Introduction:
Central vein stenosis and stenosis in mature arteriovenous fistulas (AVF) are common and are negatively impacting the quality and longevity of AVF. Here we report the outcome of central venoplasty and fistuloplasty in the treatment of symptomatic central venous stenosis and secondary AVF failure in our centre.
Methods:
This was an observational study. Data were captured using a proforma after proper consent, tabulated using MS Excel and results projected as bar graphs, pie charts or tables. The study period taken was from September 2023 to August 2024. Central venoplasty was preceded by venography. The right or left common femoral and venous limb of fistulas were used as access, sometimes ipsilateral internal jugular vein was also used as third access, followed by gradual balloon dilatation. For fistuloplasty arterial limb was used as an access followed by serial balloon dilatations.
Results:
A total of 100 patients were taken in the study, of which 63 were male and 37 were female.
Primary venoplasty was done in 28% and secondary venoplasty interventions were done in 72%.
Native Kidney disease was Diabetic Kidney Disease in 40%.
HD vintage of more than 3 years was observed in 64%.
56% were successful, and 44% failed.
Restenosis developed in 12 patients (12%)
These cases had multiple collaterals, chronic thrombus in venography, presented late (more than 3 months), had type 2 diabetes mellitus and Hypertension.
7 patients underwent fistuloplasty, mostly being male. Mean HD vintage was 2.46 years.
Radio cephalic AVF - 28.5%, Brachio cephalic AVF - 57.14%, Brachio basilic AVF - 14.28%
Conclusions:
This outcome analysis suggests that central venous stenosis and secondary AVF failure are important causes of hemodialysis access failure and recanalisation is useful for access salvage. Fistuloplasty is a valuable modality in extending the functional life of AVF but restenosis remains the main limitation.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.