Nonmaturing Fistulae: Epidemiology, Possible Interventions, and Outcomes

Area of Science:

• Vascular Surgery
• Nephrology
• Interventional Radiology

Background:

• Autogenous arteriovenous fistulae are the preferred method for long-term dialysis access.
• Radiocephalic fistulae have a high primary failure rate, up to 70%.
• Fistula maturation is hindered by demographic factors and anatomical barriers.

Purpose of the Study:

• To identify and categorize anatomical barriers affecting arteriovenous fistula maturation.
• To highlight the prevalence and impact of venous stenoses as a common barrier.
• To emphasize a systematic approach for treating these barriers to improve fistula success.

Main Methods:

• Noninvasive ultrasound imaging to identify anatomical issues.
• Physical examination to detect potential obstructions.
• Categorization of barriers into inflow (arterial) and outflow (venous) problems.

Main Results:

• Anatomical barriers significantly impact fistula maturation.
• Inflow problems include native arterial disease and anastomotic stenosis.
• Outflow problems commonly involve proximal venous stenosis and collateral veins, with venous stenoses being most frequent.

Conclusions:

• Addressing anatomical barriers, particularly venous stenoses, is key to improving fistula maturation.
• A systematic interventional approach can enhance the usability of dialysis fistulae.
• Optimizing fistula access through barrier treatment improves long-term dialysis outcomes.