The femoral artery: An alternative safe and effective cannulation localization in the angiographic treatment of dysfunctional arteriovenous fistulas. Single-center experience; long term outcomes

Abstract

Background: There is no consensus on optimal puncture localization in percutaneous transluminal angioplasty (PTA), the primary treatment modality for treating dysfunctional arteriovenous fistulas (AVF). In this retrospective single-center study, we present the early and late results of our PTA interventions performed with femoral artery puncture to treat dysfunctional AVF. Material and Methods: This study included 29 hemodialysis patients diagnosed with AVF dysfunction between January 2016 and June 2021 and therefore underwent PTA with femoral artery puncture. The patient’s demographic, clinical, and outcome data were obtained from the hospital database and electronic records of the patient’s hemodialysis center. Results: 29 hemodialysis patients (72.4% male) who underwent PTA for AVF dysfunction were followed for 53.0 (47.0-58.0) months. The patients median age was 61 (IQR 55.0-68.0). Paclitaxel-eluting balloon angioplasty was performed in 27 patients. The clinical success rate of the procedure was 93.1%. Local hematoma developed at the femoral artery puncture site in two patients. No other complications were observed. AVFs were still functional in 25 (82.8%) patients at the end of follow-up. The multivariate Cox regression analyses determined that anticoagulant/antiaggregant drug noncompliance independently predicted recurrence. Conclusion: The PTA performed via the femoral artery puncture is an effective and safe treatment modality for AVF dysfunctions. The risk of recurrence is exceptionally high in non-compliant patients with antiaggregant/anticoagulant treatment.