Endovascular Treatment of Malfunctioning Dialysis Fistulas: A Multicenter Retrospective Analysis Comparing Transradial and Conventional Transvenous Access

Abstract

Background: Venous outflow is the favored access for endovascular management of dialysis fistulas. However, transradial access (TRA) offers advantages in specific clinical scenarios. The study aims to compare the efficacy, feasibility, and safety of TRA and transvenous access (TVA) in the endovascular management of malfunctioning dialysis fistulas, addressing the existing gap in comprehensive literature.

Methods: A retrospective multi-center analysis included prospectively collected data (January 2021-November 2023) from patients undergoing endovascular management of malfunctioning dialysis fistulas with TRA. Control groups comprised patients with TVA.

Results: Of 206 patients, 62 underwent TRA, and 144 underwent TVA. Baseline demographics showed a well-matched distribution. TRA exhibited longer cannulation times but similar procedural and fluoroscopy times. Technical success rates were high for both TRA (98.4%) and TVA (97.2%). Clinical success rates were comparable (96.8% vs. 95.8%). Postprocedure access flow rates and complications demonstrated no significant differences.

Conclusions: This study provides the first direct comparison of TRA and TVA in malfunctioning dialytic fistulas. While venous outflow remains the standard vascular access site for managing malfunctioning dialysis fistulas, TRA shows comparable efficacy, safety, and feasibility, making it a viable alternative in specific clinical contexts. Further studies are needed to confirm these findings and to determine the long-term durability of TRA.

Keywords: endovascular management; hemodialysis fistula; malfunctioning dialysis fistulas; radial artery; transradial access; transvenous access.

Figure 1

Digital Subtraction Angiography depicting a proximal radio‐cephalic fistula along with a tight stenosis of the arterial inflow (A). The target lesion had initially been addressed through a transvenous approach; however, following a technical failure, a transradial access was performed. The lesion was successfully crossed, angiography was performed using a 4French diagnostic catheter positioned in the brachial artery, and a percutaneous transluminal angioplasty of the target lesion was accomplished (B). Digital Subtraction Angiography, performed from the arterial inflow (C) and the introducer sheath (D), demonstrating the technical success.