Related Experiment Video
Updated: Aug 21, 2026
Technical Aspects of the Mouse Aortocaval Fistula
Published on: July 11, 2013
Vascular access stenosis: comparison of arteriovenous grafts and fistulas
Ivan D Maya1, Rachel Oser, Souheil Saddekni
1Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA.
Insights
Vascular access stenosis is common in hemodialysis patients, but angioplasty outcomes are similar for arteriovenous fistulas and grafts. Female sex, residual stenosis, and high postprocedure pressure predict shorter access patency.
Area of Science:
- Nephrology
- Vascular Surgery
- Interventional Radiology
Background:
- Vascular access stenosis is a common complication for hemodialysis patients.
- Limited literature compares stenosis features and angioplasty outcomes between arteriovenous fistulas and grafts.
Purpose of the Study:
- To compare stenosis characteristics and angioplasty outcomes in hemodialysis patients with arteriovenous fistulas versus grafts.
- To identify clinical factors predicting access patency after angioplasty.
Main Methods:
- Prospective data collection for patients undergoing fistulogram for suspected access stenosis over two years.
- Angioplasty performed for >50% stenosis; recording lesion characteristics and pressure ratios.
- Multivariable analysis to assess factors influencing intervention-free access survival.
Main Results:
- Fistulas had significantly lower rates of significant stenosis (39.4%) compared to grafts (68.7%).
- Among stenotic accesses, fistulas were less likely to have multiple lesions.
- Technical success and intervention-free survival were similar between fistulas and grafts post-angioplasty.
Conclusions:
- Clinical evaluation for stenosis has lower predictive value for fistulas than grafts.
- Angioplasty technical success and primary patency are comparable for both access types.
- Female sex, residual stenosis, and high postprocedure access pressure ratio predict reduced access patency.
Background:
Vascular access stenosis is a frequent problem in hemodialysis patients. There is little published literature comparing the features of stenosis between arteriovenous fistulas and grafts, relative outcomes of elective angioplasty, and clinical factors predictive of access patency after angioplasty.
Methods:
Prospective data were collected for all patients referred for a fistulogram during a 2-year period because of suspected access stenosis. Angioplasty was performed if there was greater than 50% stenosis. For each procedure, we recorded the number and location of stenotic lesions, degree of stenosis (on a scale of 1 to 4), and ratio of access to systemic systolic pressure. All subsequent access procedures were tracked prospectively to calculate intervention-free access survival. Multivariable analysis was used to evaluate clinical factors affecting access patency after angioplasty.
Results:
Five hundred forty-three fistulograms were obtained: 358 in grafts and 185 in fistulas. The likelihood of finding a significant stenosis was substantially lower in fistulas than grafts (39.4% versus 68.7%; P < 0.001). Among patients with a significant stenosis, those with fistulas were less likely to have 2 or more stenotic lesions (12.5% versus 33.1%; P < 0.001). After angioplasty, degree of stenosis (1.35 +/- 0.70 versus 1.23 +/- 0.52) and access to systemic pressure ratio (0.34 +/- 0.15 versus 0.32 +/- 0.14) were similar between fistulas and grafts. Intervention-free survival was similar for fistulas and grafts (median survival, 7.5 versus 6.2 months; P = 0.36). Using multivariable stepwise proportional hazard regression analysis, only female sex, residual access stenosis, and postangioplasty access pressure ratio greater than 0.4 significantly predicted access survival (P = 0.0006).
Conclusion:
The positive predictive value of clinical evaluation for access stenosis is substantially lower for fistulas than grafts. The technical success of angioplasty and subsequent primary patency are similar for fistulas and grafts. Finally, female sex, residual stenosis, and high postprocedure access pressure ratio are each predictive of shorter access patency after elective angioplasty.
Related Concept Videos
01:25Hemodialysis I: Introduction
01:19Anastomoses
Anastomoses can be formed at arterial, venous, and lymphatic vessels.
Arterial Anastomosis: These occur between arteries. They are most common in...