1Mohamed Redha Saker,1Sebti Draouat

1Chu Benbadis

Introduction(s):

Native arteriovenous fistula (AVF) is the vascular access of choice for chronic hemodialysis patients because of its longevity and low rate of complications which are dominated by stenosis. Ultrasound-guided angioplasty of peripheral AVF stenosis in hemodialysis patients constitutes a minimally invasive percutaneous endovascular therapeutic alternative intended to restore a vascular caliber satisfactory for the correct functioning of the AVF.

Material(s) and Method(s):

Our study is prospective for evaluation of a series of 24 patients with end-stage chronic renal failure, hemodialysis and who present with stenosis of the AVF drainage vein, treated in the interventional radiology department of the Benbadis hospital in Constantine, over a period of 23 months from December 2019 to October 2021. The patients included had a significant stenosis ≥ 50% compared to the adjacent segment considered normal associated with a low flow of the AVF. All the patients in our study underwent

Doppler ultrasound exploration of the AVF before and after ultrasound-guided angioplasty. We performed 36 angioplasties in 24 patients without fluoroscopic guidance or contrast product and analyzes were performed using Microsoft Excel software.

Result(s):

A total of 36 angioplasties performed in 24 included patients, aged on average 51.08 ± 14.25 years with a slight female predominance and a sex ratio of 0.85. Risk and comorbid factors are dominated by hypertension (95.8%), diabetes (20.8%) and tobacco (25%). The age of AVF varies between 1 and 7 years, 100% of native AVF (n=24), 50% of fistulas are proximal (n=12) and the other half are distal, 50% are radiocephalic, 41.7% brachiorocephalic (n=10) and 8.3% brachiobasilic (n=2), 75% of patients (n=18) presented a low flow of the AVF and 62.5 % (n=15) of prolonged bleeding time. 45.8% of the stenosis were juxta-anastomotic, 41.7% post-anastomotic and 20.8% of the cephalic arch. In 58.3% the catheterization was retrograde. We used very high pressure (40 atm) expansion balloons in 50%. All angioplasties are performed with 100% technical success. Percentage increase in caliber is 115.13 ± 40.88% and that of increase in AVF flow rate is 156.13 ± 77.28%. The percentage of minor complications that occurred during the 36 angioplasties was 5.55% (n=2) represented by partial vein thrombosis and a small parietal hematoma. The average time required for an ultrasound guided angioplasty is 40 minutes.

Conclusion(s):

Exclusive ultrasound guidance angioplasty of peripheral AVF stenosis is a feasible, effective and safe technique, allowing vital venous capital to be preserved for hemodialysis patients while hoping for definitive treatment of IRCT by renal transplantation.