Optimizing hemodialysis arteriovenous fistula maturation

To review why hemodialysis fistulas fail to mature and how percutaneous techniques can salvage them.

A review of the medical literature was performed, with specific attention to the location of the lesions, the types and the numbers of procedures performed, salvage and patency rates.

Using balloon angioplasty of the arteries and/or veins with sequential dilation if needed and ligation or embolization of collateral side branches the fistula that has failed to mature can be salvaged. Usually, more than one procedure is required to salvage a fistula; however, salvage rates of 75-95% are achieved with 1 yr primary patency rates of 30-60%. With repeat percutaneous interventions, 1 yr secondary patency rates are 75-90%.

With surveillance and aggressive follow-up after placement, early intervention (primarily dilation in the access circuit) can yield high salvage rates in fistulas that fail to mature.