Endovascular salvage of nonmaturing autogenous hemodialysis fistulas: comparison with endovascular therapy of failing mature fistulas.

Purpose To evaluate the utility of endovascular salvage of nonmaturing autogenous hemodialysis fistulas in a prospective trial of consecutive patients compared with a historical group of patients who underwent treatment of failing mature autogenous fistulas. Materials and Methods During a 12-year period, angiography revealed anatomic lesions in 75 fistulas with maturing problems (72 radiocephalic and three brachiocephalic). Endovascular therapy through antegrade arterial access was attempted in 72 fistulas. A series of 45 consecutive patients who underwent endovascular salvage of failing mature fistulas was used as a control group. Results A technical success rate of 88% (66 of 75) and a clinical success rate of 87% (65 of 75) were achieved for the nonmaturing fistulas. Including the secondary interventions, the rate of complications was 6.1% (eight of 131). By Kaplan-Meier analysis, the primary clinical patency rates were 43% ± 6% (±SEM), 36% ± 6%, and 23% ± 6%, and the secondary patency rates were 76% ± 5%, 68% ± 6%, and 57% ± 8% at 6, 12, and 36 months, respectively. A small inflow artery ( P = .01). The secondary patency rate of nonmaturing fistulas at 3 years was worse than that of mature fistulas, at 57% ± 8% versus 79% ± 8% ( P = .02). Conclusions A functional fistula was achieved in 87% of nonmaturing fistulas. Although the functional time gained in these fistulas is shorter than that gained in failing mature fistulas, more than half of nonmaturing fistulas are functional after 3 years.