Percutaneous interventions to support failing hemodialysis fistulas and grafts

Different methods of percutaneous management offer an approach to nearly every type of failing hemodialysis fistula. Technically, shunt intervention is highly successful and associated with a low complication rate. It is quick, inexpensive and can be performed on an outpatient basis with immediate dialysis via the fistula thereafter. Nearly all techniques of interventional radiology have their place in this strategy and skilled training is mandatory to achieve excellent results. Reobstruction has to be accepted as part of the process. Frequent but timely reintervention is therefore part of shunt maintenance and protection.