A SINGLE CENTRE EXPERIENCE OF USG GUIDED INTERVENTIONAL PROCEDURES ON AV FISTULA

Introduction:

Access is the achilis heel of ckd patients on maintainance hemodialysis. Av fistulae is always preferred as access because of its long-term patency, lower infection rate, low cost. Av fistula stenosis/thrombosis is common and may lead to access failure. Usg guided percutaneous procedures are recently being used for access salvage.

Methods:

This is an Observational study. All data was captured using preformed proforma. The data obtained via the proforma was tabulated using MS excel and all results projected in form of bar graphs, pie charts, histograms. All patients included in the study consented for the procedure as well as collection of data. From January 2023 to December 2023 36 cases of usg guided avf interventions was performed. Procedures were performed on both outpatient or inpatient basis. Depending on area of stenosis, the interventions were carried out through the cannulation of the efferent veins or inflow artery in a retrograde or anterograde direction. Minimum follow up period was 6 months.

Results:

Of total 36 cases, most common site of stenosis was peri-anastomotic in 21 cases (58.33%), in distal efferent vein 10 cases (27.77%), in proximal artery 5 cases (13.88%). Success rate of usg guided PTA was 85.71% for perianastomotic area, 90% for stenosis distal effector vein, 80% for stenosis in proximal artery. 2 cases required salvage by using fluoroscopic guidance and 3 cases stricture could not be negotiated. Mean AVF patency was 1.13 years (SD 2.2 months) Restenosis was in 1.8/100 patient months of follow up. Adverse events were minor bleeding in 16.66%, Major bleeding 5.55%, Arterial thrombosis 5.55 %, Pseudoaneurysm- 2.77% (brachial art access), venous rupture 13.88%, Death 0 cases.

Conclusions:

from our limited experience of past 2 years in our institution, usg guided endovascular procedures may be the first step to salvage the failing av fistula particularly in a resource poor setting. It is a low-cost procedure, avoids the fluoroscopy exposure for both treating doctor and patient. However, there are limitations. First of all, it is not possible to gain a full view of the vascular district. Fluoroscopy allows a better control of the guides and facilitates the intravascular navigation. Usg guided endovascular PTA may not be sufficient in the presence of many collateral venous, in case of very tight stenosis or tortuous vessel course and in case of arterial stenosis.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.