Staged endovascular management for non-maturing arteriovenous fistulas: A single-center retrospective cohort study

This study aims to assess the efficacy and safety of a staged endovascular management for non-maturing arteriovenous fistulas (AVFs) and identify prognostic factors associated with patency.

Between September 2016 and June 2025, 67 patients (age: 62.8 ± 10.8 years; male: 67.2%) underwent staged endovascular management according to a standardized institutional protocol. This strategy prioritizes correction of underlying stenotic lesions, even when the severity of stenosis is mild. Embolization of collateral veins was performed in cases of persistent maturation failure.

Technical and clinical success rates were 97.4% (76/78) and 83.6% (56/67), respectively, with a complication rate of 5.1% (4/78). Initial PTA achieved clinical success in 54 of 67 patients (80.6%). Among 11 patients with persistent maturation failure, four underwent collateral embolization, resulting in clinical success in 2. Postintervention primary and assisted primary patency rates at 3, 6, and 12 months were 85.7%, 81.7%, and 73.1%, and 98.2%, 96.3%, and 94.2%, respectively. Diabetes mellitus (HR, 5.43; 95% CI, 1.23-23.96; p = 0.026) and thrombotic occlusion (HR, 7.05; 95% CI, 2.62-18.93; p < 0.001) were significant predictors of reduced primary patency. The reintervention rate was 0.45 events/access-year. Outcomes did not differ significantly according to lesion characteristics.

A staged endovascular approach offers a safe and effective strategy for managing non-maturing AVFs, enabling tailored clinical decision-making with favorable patency outcomes. The identification of diabetes mellitus and thrombotic occlusion as predictors of primary patency enables more precise risk stratification.