Effectiveness of endovascular treatment in native hemodialysis fistula dysfunction: long-term outcomes

Abstract

Objectives: This study aimed to present our single-center experience on the efficacy of endovascular treatment for the dysfunction of hemodialysis arteriovenous fistulas (AVF). Methods: This retrospective study analyzed 110 patients with hemodialysis AVF dysfunction who underwent endovascular treatment. Patients were evaluated with Doppler ultrasound, and those with significant stenosis or thrombosis were treated using balloon angioplasty, tissue plasminogen activator (t-PA), and/or thrombectomy, or a combination of both. A transvenous approach was performed in all cases, and post-procedural patency was assessed with fistulography. The primary outcome was defined as achieving stenosis reduction below 30%, with follow-up patency recorded at 3 and 6 months. Long-term fistula patency times and the frequency of repeat interventions were also evaluated. Statistical analysis was conducted to evaluate patency outcomes and procedural success rates. Results: Primary patency was achieved in 90.9% of patients, with balloon angioplasty significantly improving patency rates (p = 0.0077), while t-PA and thrombectomy showed no significant impact. At the 3-month follow-up, 83% of patients maintained patency; at 6 months, this rate decreased to 72.7%. ANOVA analysis showed no significant differences between treatment groups in long-term patency time (p = 0.322). The mean fistula patency duration was most prolonged in patients treated with balloon angioplasty alone (21.8 months), followed by those who received combination therapy (19.2 months), and shortest in those treated with only t-PA or thrombectomy (14.7 months). However, differences were not statistically significant (p > 0.05). A total of 21 patients required repeat interventions, with an average patency duration of 25.13 months after reintervention. Conclusions: This study suggests that endovascular treatment, especially balloon angioplasty, plays a key role in maintaining fistula patency.