Abstract
Vascular access complications are the leading cause of morbidity in patients with end-stage kidney disease. The most common pathology is vascular stenosis, that can be located in any part of the fistula circuit and is a cause of fistula dysfunction.
High-grade stenosis (and mainly those located in the inflow part of the fistula) can lead to thrombosis and loss of the fistula if left untreated. With endovascular interventions, we can treat stenosis, restore fistula function and prevent fistula loss, all of that with minimally invasive approach.
Endovascular approach can also be used for fistula declotting, although is a time and money consuming procedure, it is better to be avoided by timely intervention.Rather rarely needed type of intervention in a dialysis fistula is endovascular embolization - closure of the vessel. It can be used to treat steal syndrome, to remodel outflow tract of the fistula (when side branches of outflow vein are embolised to redirect the flow to the main outflow vein) or if we need to close the fistula from different reasons.
Patients with dialysis fistula require very complex interdisciplinary care and an interventional radiologist as a part of the team can help to preserve the function of the fistula and to treat possible complications. The goal is to avoid the need for surgical creation of a new fistula, as there are only so many locations where the fistula can be created and when outflow veins are exhausted, the only possibility is to insert a dialysis catheter.