1Vimal Chacko Mondy,1Anoop A
End-stage renal disease (ESRD) is increasing incidence with many patients requiring renal replacement therapy (RRT). Limitation of donor availability and high economic cost preclude the procedure in many patients. Hemodialysis is the most commonly done RRT and is usually done by creating an arteriovenous fistula (AVF) which can be either native or graft AVF. There are many associated complications with AVF requiring surgery or intervention requiring surveillance for early identification and appropriate treatment.
Material(s) and Method(s):
The various causes of hemodialysis AVF failure and its clinical presentations. The role of ultrasound in the surveillance of AVFs The different endovascular treatment options for failing arteriovenous fistula with representative examples.
Stenosis in the AVF circuit is the most common cause of failing fistula, and the treatment of choice is balloon angioplasty. The various endovascular therapeutic options in other complications include thrombolysis or mechanical thrombectomy, venoplasty for thrombotic occlusions, angioplasty for central venous stenosis, stenting for failed angioplasty, or rapid recurrence of stenosis embolization of early draining veins if it is the cause for non-maturation of AVF or secondary failure. Distal hypoperfusion ischemia syndrome due to arterial stenosis is treated by balloon angioplasty to improve distal flow.
As the number of AVFs created for hemodialysis increases, knowledge of its hemodynamics, associated complications, and interventional radiology techniques for its management are essential for an interventional radiologist.