Long-term Outcomes of Patch Angioplasty Maturation for Arteriovenous Fistulas

Autogenous arteriovenous fistulas (AVFs) have a primary failure rate of 20% to 60%. Patch angioplasty maturation (PAM) is a novel technique to assist in the maturation of AVFs. PAM has previously been shown to deliver excellent short-term results with 92% of PAM AVFs progressing to function for hemodialysis. The purpose of this study is to assess the long-term outcomes of PAM AVFs. A single-center, retrospective cohort study was performed of adults age 18+ who underwent PAM between January 1, 2007, and December 31, 2019. PAM was performed with bovine pericardial patch (2 cm × 9 cm or 2.5 cm × 15 cm) of adequate length to correct AVF stenosis/nondilation as seen in Fig 1. Outcomes were considered successful if the PAM AVF was functional for the most recent hemodialysis of record with notation of primary patency (no additional procedures) and secondary patency (including additional procedures). The outcomes of interest were primary and secondary patency censured for death and loss to follow-up. Descriptive statistics and Kaplan-Meier estimations determined time of overall patency (censored for death, kidney transplant, peritoneal dialysis, and <12 months follow-up). During the study interval, 164 PAM AVFs were performed with 12 failures to mature, and 6 patients excluded due to death or loss of follow-up. Demographics of the cohort with successful maturation (n = 146) included mean age of 67 ± 12.9 years, 56% male, 39% White Non-Hispanic, 94% hypertensive, and 66% diabetic. PAM AVF configurations included both radiocephalic (33% proximal radial, 27% distal radial) and brachiobasilic (27%). The mean patency for the cohort was 120 months. Primary patency was: 1-year, 64% (70/109); 2-year, 54% (44/82); 3-year, 46% (27/59); 4-year, 39% (14/37); and 5-year, 35% (10/25). Similarly, secondary patency was as seen in Fig 2; 1-year, 95% (104/109); 2-year, 88% (72/82); 3-year, 83% (49/59); 4-year, 75% (28/37); and 5-year, 73% (18/25). Secondary patency was established using both endovascular and surgical techniques. PAM is an effective procedure to salvage AVFs that failure to mature adequately for hemodialysis. This analysis examined the long-term function of the PAM AVF construction and found very acceptable primary and secondary patency to maintain dialysis access in patients with otherwise failing AVFs. The PAM technique should be considered for those AVF that fail to mature prior to abandoning them for another access.Fig 2Kaplan-Meier estimator of arteriovenous fistula (AVF) secondary patency after patch angioplasty maturation (PAM).View Large Image Figure ViewerDownload Hi-res image Download (PPT)