Should all inflow stenoses be treated in failing autogenous hemodialysis fistulae?

To determine whether angioplasty of inflow stenosis in malfunctioning but patent autogenous hemodialysis fistulae has an impact on postintervention primary patency in patients without a clinical indicator of inflow-related access malfunction.

Medical records for 76 procedures in 62 patients with inflow stenoses undergoing fistulography in nonthrombosed mature autogenous fistulae without an inflow-related indication of access malfunction over a 5-year period were reviewed retrospectively. Control and treatment arms were defined as patients with untreated (26 procedures in 23 patients) and treated (50 procedures in 39 patients) inflow stenoses, respectively. All patients in both arms of the study had concurrent intrafistula and/or venous outflow stenosis, which were treated successfully with angioplasty. The clinical endpoint was defined as return for a failing or thrombosed access (ie, primary patency). A two-tailed unpaired Student t test was performed to compare primary patency and percent inflow stenosis in treatment (angioplasty) and control (untreated inflow stenoses) groups, with significance defined at P < .05. Kaplan-Meier analysis was performed.

There was no significant difference in percent inflow stenosis between control and treatment arms (P = .95). There was no significant difference in access patency between the two groups (139 and 124 d for control and treated groups, respectively; P = .95). No procedural complications occurred in either arm of the study.

Angioplasty of inflow stenosis in failing autogenous fistulae without an appropriate clinical indicator of an inflow pathologic process does not improve postintervention primary patency.