Venous Stenosis as the Primary Cause of Arteriovenous Fistula Failure

Evidencia de las Guías Clínicas

The American College of Radiology recommends that venous stenosis is the primary cause of arteriovenous fistula failure, with evidence from angiographic studies showing it to be the cause in up to 100% of cases 1, 2
Turmel-Rodrigues et al. report that a failed arteriovenous fistula is precipitated by a coexisting venous stenosis in 100% of patients evaluated with diagnostic fistulography, according to the American College of Radiology guidelines 1, 2, 3

A hemodynamically significant stenosis results in smaller diameters and reduced blood flow, a finding that was significant in the Hemodialysis Fistula Maturation (HFM) study, as reported by the American College of Radiology 1, 2, 5
Venous stenosis develops due to intimal hyperplasia, lack of venous and arterial dilation, presence of scarring in the outflow vein, and atherosclerotic disease, according to the American College of Radiology 1, 2, 3

Competitor venous collaterals can divert blood flow from the main outflow vein, although prospective studies did not find a significant relationship with non-maturation, as reported by the American College of Radiology 1, 2, 5
Arterial problems (arterial stenosis, arteriosclerotic narrowing of the feeding artery) are found in an increasing proportion of elderly, hypertensive, and diabetic patients, but are less frequent as a primary cause, according to the American Journal of Kidney Diseases 4, 6

Percutaneous angioplasty of venous stenosis achieves salvage of 83-88% of non-maturing arteriovenous fistulas, with a reported clinical success rate of 92%, according to the American College of Radiology 1, 3
Arteriovenous fistulas that have not met maturation criteria after 2 months are candidates for endovascular therapies, specifically balloon angioplasty of venous stenosis, as recommended by the American College of Radiology 1, 2
The maximum acceptable residual stenosis post-treatment is <30%, with restoration of a palpable thrill as the best predictor of optimal long-term outcomes, according to the American College of Radiology 1, 3