Stenoses in dialysis fistulas: treatment with percutaneous angioplasty

Percutaneous transluminal angioplasty (PTA) was performed on 30 stenotic lesions in 25 dialysis access fistulas. The fistulas were in 23 patients with a mean age of 53 years. Lesions were detected with angiography within a few days after poor flow or increased venous pressure was documented during dialysis. Twenty-two lesions were in patients with polytetrafluoroethylene graft fistulas, five were in patients with bovine carotid fistulas, and three were in patients with endogenous arteriovenous fistulas. There were 28 venous stenoses (20 at the anastomotic site and eight more proximally) and two arterial stenoses. The overall success rate was 80%, with a 6-month patency of 76% and a mean patency after PTA of 9.4 months. Among the venous lesions, the success was 100% for proximal lesions and 71% for anastomotic lesions. There were two technical failures, which required surgery for revision of the fistulas, and four self-limited hematomas. PTA is a safe and effective treatment for stenoses in dialysis fistulas, particularly for lesions remote from the anastomotic sites.