Ultrasound-guided fistuloplasty: A novel office-based technique for arteriovenous fistula salvage

Introduction: Alongwith the increasing awareness of fistula for dialysis, there has been an increasing utilization of endovascular interventions to create and maintain native Arterovenous fistulas. So far the widely practiced corrective endovascular options are fistulogram and plasty. However with most target segments being superficial veins of the outflow channel with juxta anastomotic lesions, ultrasound guided fistuloplasty is a promising answer to such a clinical scenario. Methods: All patients with diagnosed outflow vein obstruction with dialysis disturbance and no evidence of central vein stenosis were subjected to the procedure. Results: Satisfactory dialatation was achieved in 84% of patients at the end of one month. Only four patients required adjunctive procedure prior to dialysis. The most common procedure related side effect was hematoma- in 08 ( 19%) of patients, however they were non expanding and self resolving- limited to the area around the plasty site. Conclusion: The procedure can be accomplished in office setting avoiding the exposure of dye and radiation. It also decreases the burden on health care in operating theatres and decreases cost and time of hospitalization. However central vein stenosis and cephalic arch stenosis are definitely limitations of the procedure.