Juxta-anastomotic stenosis in the forearm native arteriovenous fistula: Open surgery or angioplasty?

Background: The juxta-anastomotic stenosis (JAS) represents the major complication of arteriovenous fistula (AVF) during the first months after the surgery and the approach to JAS can be surgical or radiological.

Methods: From 01/02/2016 to 31/12/2020, a total of 976 radiocephalic fistulas have been performed. The 15.9% of AVF was malfunctioned due to JAS. A retrospective analysis was conducted on 156 patients with JAS, in order to compare the primary outcome of surgery and percutaneous angioplasty (PTA) in JAS treatment, in the lower forearm in a follow-up of 24 months.

Results: Ninety patients underwent to surgery and 66 to PTA, mean age was 63.43 ± 14.54 and 65.10 ± 15.10 years, respectively. Frequencies of diabetes mellitus and arterial hypertension were similar by groups. Cardiovascular disease was present in 20% of the surgery patients and in 42.4% PTA patients (p = 0.04). The primary assisted patency was 84.4% and 71.1% in the surgery group at 12 and 24 months and 54.5% and 69.6% in the PTA group. The secondary patency at 24 months was 95.6% for surgery group and 96.9% for PTA group, without a statistical significance. During the study period, 10 AVFs (11.1%) showed a restenosis in the surgical group and 14 (21.2%) in the PTA group.

Conclusions: This retrospective study suggests a higher restenosis rate after PTA than surgery. However, the statistical analysis shows that the failure rate of the two procedures is comparable. A dedicated multidisciplinary team could represent the goal for a good clinical practice in the treatment of JAS.