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Dilatation is usually the best treatment for stenosis of the arteriovenous hemodialysis fistula

Nature Clinical Practice Nephrology volume 4, pages 116–117 (2008)Cite this article

Stenosis is the main complication of all types of arteriovenous access for hemodialysis. Many stenoses remain asymptomatic, or at least undiagnosed, until the occurrence of acute thrombosis. There is much controversy about the value of preventive treatment of asymptomatic stenoses; however, no-one would deny that a stenosis that is impairing dialysis or otherwise causing harm to the patient has to be treated.

Symptomatic stenoses can be treated either with surgery or with endovascular dilatation. The advantages of dilatation over surgery are clear: minimal invasiveness and better venous preservation. Small holes are left in the skin instead of long scars, with little risk of wound infection and few adverse esthetic sequelae; furthermore, only local (rather than regional or general) anesthesia is required. The abnormal vein or artery is treated in situ, and the normal vein or artery immediately upstream and downstream is preserved. This better venous preservation overall is, however, sometimes jeopardized by inappropriate stent placement (i.e. in the final arch of the cephalic vein, or in the final subclavian or brachiocephalic veins).1 Endovascular treatment can also save many fistulas that are not salvageable by conventional surgery (e.g. those that have delayed maturation due to non-anastomotic stenoses, and many thrombosed native fistulas).2,3

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  1. Department of Vascular Radiology, Clinique Saint-Gatien, 8, Place de la Cathédrale, Tours 37042, France luc.turmel@wanadoo.fr

Authors and Affiliations

  1. L Turmel-Rodrigues is an Interventional Radiologist in the Departments of Vascular Radiology at the Clinique Saint-Gatien, Tours and the Clinique Ambroise Paré, Neuilly-sur-Seine, France.,

    Luc Turmel-Rodrigues

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Turmel-Rodrigues, L. Dilatation is usually the best treatment for stenosis of the arteriovenous hemodialysis fistula. Nat Rev Nephrol 4, 116–117 (2008). https://doi.org/10.1038/ncpneph0711

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