Endovascular Arteriovenous Dialysis Fistula Intervention: Outcomes and Factors Contributing to Fistula Failure

RATIONALE & OBJECTIVE: Primary patency is variable with arteriovenous fistulas, and many patients require angiographic procedures to obtain patency. Accordingly, we determined postintervention patency rates and contributing factors for fistula failure following intervention to establish secondary patency in non–dialysis-dependent patients with advanced chronic kidney disease following creation of an arteriovenous fistula. STUDY DESIGN: Observational study from a single referral center. SETTING & PARTICIPANTS: 210 non–dialysis-dependent patients with advanced chronic kidney disease who underwent upper-extremity fistula creation for anticipated dialysis between October 1995 and January 2015 and who required subsequent endovascular therapy to establish or maintain patency were reviewed. EXPOSURE: Endovascular therapy for dialysis arteriovenous fistula primary patency failure. OUTCOMES: Postintervention patency duration following endovascular therapy. ANALYTICAL APPROACH: Descriptive study with outcomes determined using Cox proportional hazards models. RESULTS: Multiple fistula configurations were reviewed: 138 (65.7%) brachiocephalic, 39 (18.6%) radiocephalic, 30 (14.3%) brachiobasilic, 2 (1.0%) ulnocephalic, and 1 (0.5%) radiobasilic. There were 261 initial stenoses treated. Postintervention primary patency is defined as the time from the index intervention to repeat intervention for stenosis. Postintervention primary-assisted patency is the time from the index intervention to thrombectomy for fistula thrombosis or change in modality. Postintervention secondary patency is the time from the index intervention to fistula abandonment. Median postintervention primary patency, postintervention primary-assisted patency, and secondary patency were 2.7, 3.2, and 3.6 years, respectively. The overall 1-year primary, primary-assisted, and secondary patency rates in this cohort were 53.0%, 87.7%, and 83.5%, respectively. Compared with radiocephalic fistulas, brachiocephalic fistulas had higher risk for postintervention primary patency loss (HR, 1.90; 95% CI, 1.13-3.20; P = 0.02). LIMITATIONS: Dialysis fistula revascularization techniques varied. CONCLUSIONS: The radiocephalic fistula configuration had the best postintervention primary patency in this cohort. Postintervention primary-assisted patency and secondary patency were not significantly different among different fistula configurations.