Patency and functional outcomes of endovascular treatment in juxta-anastomotic venous stenosis of native arteriovenous fistulas.

چکیده اصلی

INTRODUCTION: Juxta-anastomotic venous stenosis is a frequent cause of dysfunction in native arteriovenous fistula (AVFs), compromising both maturation and long-term patency. Endovascular treatment has emerged as a minimally invasive alternative to surgical revision. We evaluated short-term patency and functionality outcomes and temporal patterns following endovascular treatment of juxta-anastomotic venous stenosis. MATERIALS AND METHODS: We conducted a retrospective single-center observational study including adult patients with native AVFs who underwent endovascular treatment for juxta-anastomotic venous stenosis between January 2020, and June 2024. Analyses were performed at the patient level using the first (index) intervention. Assisted primary patency was assessed using Kaplan-Meier survival analysis. Exploratory associations with 6-month failure were evaluated using penalized logistic regression. RESULTS: Fifty patients were included. Median age was 72 years [IQR: 65-76], and 72% of patients were male, with a high burden of cardiovascular comorbidity. At intervention, 72% were on hemodialysis and 28% were followed in advanced chronic kidney disease (ACKD). Delayed AVF maturation accounted for 46% of cases. The median time from AVF creation to stenosis detection was 112.5 days (IQR 60.5-511), indicating heterogeneous temporal presentation. Stenosis was detected significantly earlier in AVFs treated for delayed maturation compared with established accesses (median 68.5 vs 388.5 days; p=0.001). Conventional balloon angioplasty was performed in 98% of index procedures, with selective use of cutting balloons and drug-coated balloons. During 6-months of follow-up, 8 access failures occurred. Kaplan-Meier estimates of assisted primary patency were 90% at 90 days (95% CI 0.78-0.96) and 84% at 180 days (95% CI 0.71-0.92). Functional success at 6-months was 90% of patients. CONCLUSIONS: In this single-center retrospective cohort, endovascular treatment was associated with high short-term assisted primary patency and functional success. These results represent real-world descriptive data and require confirmation in prospective studies with longer follow-up and comparative designs. .

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