Case series for Transradial Approach in Fistulograms for Arteriovenous Access.

Abstract

Introduction: Traditional endovascular interventions for arteriovenous (AV) access procedures typically are performed with direct fistula or graft puncture. The transradial approach (TRA) offers both arterial and venous limb visualizations and therapeutic interventions through a single access point. Our objective was to assess clinical success, functional patency, flow rates, and complications in patients undergoing TRA fistulograms.

Methods: A retrospective analysis was conducted on patients who underwent TRA fistulograms between 2017 and 2023. Patient demographics, stenotic lesion type, and 3-month postoperative complications were analyzed. Patency and clinical success were assessed by measuring flow rates before the operation and at 1-month, 3-month, and 6-month intervals afterward. Paired t-tests were performed to compare flow rates prior to and after intervention.

Results: A total of 255 patients (mean age 61.9 years, 58% male) underwent TRA fistulograms.The predominant lesion types were venous outflow (71%), juxta-anastomotic (8.6%), and mixed between the two (12.2%). The mean preoperative flow rate was 456.5 cc/s, increasing to 751, 878, and 741 after one, three, and six-months, respectively. Flow rates were significantly higher in at the one and three and 6-month intervals (p < 0.05). Technical success was observed in 94.9% of cases and complications included ruptures in 1.6% of cases, access site complications in 3.9% of cases, and AV fistula thrombosis in 6.7% of cases.

Conclusions: The TRA for fistulograms offers functional patency rates that show significant improvement in those with malfunctioning AV access while offering minimal complications. This method offers a convenient alternative to traditional access, specifically for venous and juxta-anastomotic lesions through a single puncture.