Angioplasty in CKD patients with immature AV fistula: A Case Report

Abstract

Arteriovenous fistula has been preferred to other vascular access for dialysis due to better patient outcome for morbidity and mortality. However, AVF failure is quite prevalent. One of the cause for AVF failure is due to venous stenosis, diagnosed through Doppler ultrasound and venography. Angioplasty is one of the methods that can be used to repair and salvage an immature AVF. In this report, a 59 year old female patient was diagnosed with CKD with a long history diabetes mellitus type 2 and admitted for routine hemodialysis. An AVF was created on her radiocephalic vein, and upon evaluation was found to not mature properly. Doppler ultrasound examination showed fistula diameter of 3 mm and volume flow of 160 ml/min, whereas venography showed stenosis in radiocephalic fistula. Balloon angioplasty was then performed with balloon diameter of 4 mm and balloon pressure of 10, 15, and 20 atm for three minutes each. After the procedure, the fistula exhibit dilatation with minimum residual stenosis and adequate as vascular access for hemodialysis.