Percutaneous Endovascular Treatment of Stenosis of Dialysis Arteriovenous Fistulas

Treatment of Stenosis of Dialysis Arteriovenous Fistulas

  • Jagadeesh Pasupuleti Post graduate , Department of Radiology, Narayana medical college, Nellore, Andhra Pradesh
  • Yugandhar Samireddypalle Senior resident, Interventional Radiologist, Department of Radiology ,Narayana medical college, Nellore, Andhra Pradesh
  • Saripudi S V N P Manikanta Vijay Post graduate , Department of Radiology, Narayana medical college, Nellore, Andhra Pradesh
  • Guntaka Srujana Post graduate , Department of Radiology, Narayana medical college, Nellore, Andhra Pradesh
  • Amitha Vikrama KS Head, Department of Radiology, Bannerghatta Road, Bangalore, Karnataka


Background: The incidence of end stage renal disease is on the rise and most of these patients are undergoing dialysis either through tunneled/non tunneled dialysis catheters or through arteriovenous fistulas. The dialysis grafts and fistulas have limited durability of about 3 years and are more prone for thrombosis and stenosis, resulting in AVF dysfunction. As the number of access sites for dialysis is limited, percutaneous endovascular management by fistuloplasty has become the accepted first line of management to increase the lifespan of these fistulas.This article discusses a series of cases of AVF dysfunction secondary to draining vein stenosis managed by percutaneous transluminal angioplasty, their outcome and short term follow up till 3 months. The aim of the study is to review the role of percutaneous endovascular management of stenosis of dialysis fistulas, its indications, safety, efficacy and short term patency. Subjects and Methods: This was a prospective observational study done in department of Radio diagnosis, Narayana medical college, Nellore. About 20 cases were performed in our institution from December 2018 to August 2019. All these cases were done in angio suite after proper dialysis through temporary catheter. Post procedure doppler was done to evaluate the improvement in flow rate of these fistulas. Results: Seventeen cases were successful with immediate restoration of optimal flow rate during dialysis. (One case developed acute thrombosis of the fistula within 24 hours post procedure, which was successfully treated by needle directed thrombolysis with good patency at three month follow up). In two cases, there was failure of the procedure as the tight stenotic segment could not be negotiated. One case had early re-stenosis of the draining vein which required repeat session of fistuloplasty within one month with occlusion of the draining vein on three month follow up. Conclusion: Fistuloplasty is a minimally invasive percutaneous procedure with established safety and efficacy to restore the normal function of dialysis fistulae/grafts. The main aim of the procedure is to restore a diameter of the draining vein adequate for optimal flow rate during dialysis. Careful patient selection is required for increasing the success rate of the procedure. Repeat sessions of angioplasty is offered for re-stenosis to increase the lifespan of fistulas. Stent placement is usually avoided except for recurrent focal stenosis in precious fistulas.


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Mailloux LU, Bellucci AG, Napolitano B, Mossey T, Wilkes BM, Bluestone PA. Survival estimates for 683 patients starting dialysis from 1970 through 1989: identification of risk factors for survival. Clin Nephrol. 1994;42(2):127–135.

Chazan JA, London MR, Pono LM. Long-Term Survival of Vascular Accesses in a Large Chronic Hemodialysis Population. Nephron. 1995;69(3):228–233. Available from:

Eknoyan G, Levin N. NKF-K/DOQI Clinical Practice Guidelines: Update 2000. Foreword. Am J Kidney Dis. 2000;37((1 Suppl 1)):5–6.

Bountouris I, Kritikou G, Degermetzoglou N, Avgerinos KI. A Review of Percutaneous Transluminal Angioplasty in Hemodialysis Fistula. Int J Vasc Med. 2018;2018:1–5. Available from:

Steiner K, Dutta P, Stempel CV, Walton H, H. Percutaneous transluminal angioplasty in arteriovenous fistulas: current prac- tice and future developments. J Radiol Nurs. 2017;36(3):145–151. Available from:

Miquelin DG, Reis LF, da Silva AAM, de Godoy JMP. Percutaneous transluminal angioplasty in the treatment of stenosis of arteriovenous fistulae for hemodialysis. Int Arch Med. 2008;1(16):1–4. Available from:

MacRae JM, Dipchand C, Oliver M, Moist L, Lok C, Clark E, et al. Arteriovenous access failure, stenosis, and thrombosis. Can J Kidney Health Dis. 2016;3:1–11. Available from:

Abdelaziz O, Fahmy MA, El-Khashab SO. Role of color doppler ultrasound for assessment of arteriovenous fistula dysfunction in hemodialysis patients. Kasr Al Ainy Med J. 2018;24(2):72–78. Available from:

Wiese P, Nonnast-Daniel B. Colour Doppler ultrasound in dialysis access. Nephrol Dial Transplant. 2004;19(8):1956– 1963. Available from:

Quencer KB, Arici M. Arteriovenous Fistulas and Their Char- acteristic Site of Stenosis. Am J Roentgenol. 2015;205(4):726– 734. Available from:

Beathard GA. Percutaneous transvenous angioplasty in the treatment of vascular access stenosis. Kidney Int. 1992;42(6):1390–1397. Available from:

van der Linden J, van den Dorpel MA. Percutaneous Transluminal Angioplasty of Failing Hemodialysis Grafts and Fistulae. Saudi J Kidney Dis Transpl. 2004;15(3):333–337. Available from:

Irani FG, Teo TKB, Tay KH, Yin WH, Win HH, Gogna A, et al. Hemodialysis arteriovenous fistula and graft stenoses: randomized trial comparing drug-eluting balloon angioplasty with conventional angioplasty. J Vasc Interv Radiol. 2018;289(1):238–285. Available from:

Forauer AR, Hoffer EK, Homa K. Dialysis Access Venous Stenoses: Treatment with Balloon Angioplasty—1- versus 3- minute Inflation Times. Radiology. 2008;249(1):375–381. Available from:

Aktas A, Bozkurt A, Aktas B, Kirbas I. Percutaneous trans- luminal balloon angioplasty in stenosis of native hemodial- ysis arteriovenous fistulas: technical success and analysis of factors affecting postprocedural fistula patency. Diagn Interv Radiol. 2015;21(2):160–166. Available from:

Machado S, Ferreira A, Lucas C, Gil C, Fortes A, Neves FC. Results of endovascular procedures performed in dys- functional arteriovenous accesses for haemodialysis. Port J Nephrol Hypert. 2012;26(4):266–71. Available from:

Özkan B, Güngör D, Yıldırım UM, Harman A, Özen Ö, Aytekin C. Endovascular Stent Placement of Juxtaanastomotic Stenosis in Native Arteriovenous Fistula After Unsuccessful Balloon Angioplasty. Iran J Radiol. 2013;10(3):133–139. Available from:

How to Cite
Jagadeesh Pasupuleti, Yugandhar Samireddypalle, Saripudi S V N P Manikanta Vijay, Guntaka Srujana, & Amitha Vikrama KS. (2020). Percutaneous Endovascular Treatment of Stenosis of Dialysis Arteriovenous Fistulas. Asian Journal of Medical Radiological Research, 8(1), 21-27.