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AVF Stenosis

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Dr Raghunandan Prasad, Lucknow    31 December 2018

  • Arteriovenous fistula (AVF) is the lifeline of ESRD patients on maintenance hemodialysis (MHD). It is the best available vascular access option.
  • It has superior patency and longer access survival rates, lower complication rates, less morbidity and mortality, and is economical.
  • AVF remains the lifeline and at the same time the Achilles heel for CKD patients because of frequently developing stenotic lesions.
  • Etiopathophysiological factors: Trauma to the vein due to the vene-puncture prior to fistula placement (pre-existing venous stenosis); neointimal hyperplasia and adverse vascular remodeling; secondary to fibromuscular hyperplasia due to repeated trauma from dialysis needle.
  • Prevention - Piggyback straight onlay technique, in which the anastomosis is formed between the underside of the more superficial cephalic vein and the anterior aspect of the deeper radial artery.
  • Angioplasty is highly successful if done at the right time and in a right manner.
  • Still, lot of research and optimization of treatment is required as recurrence rate of stenosis is quite high.

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