Endovascular treatment of proximal venous outflow obstructions in patients with arteriovenous fistula: Our single-center experience

Objectives: In this study, we present our early and mid-term results of percutaneous treatment for proximal venous outflow obstruction (PVOO). Patients and methods: Between January 2017 and July 2019, a total of 40 patients (19 males, 21 females; mean age: 61.9±12.1 years; range, 49 to 74 years) who underwent hemodialysis from the arteriovenous fistula (AVF) were included. All patients had advanced edema due to PVOO in the extremity with AVF. All patients received endovascular treatment for PVOO. Results: Percutaneous transluminal angioplasty (PTA) was performed to all patients. Stent implantation was performed in 20 patients who could not achieve full patency after PTA. A patient whose edema did not regress despite stent implantation underwent surgical AVF recreation. A total of six patients underwent minor/major surgical procedures. In 14 patients, edema completely regressed and the functionality of the fistula increased in the one-month follow-up after the PTA procedure. The patients who underwent percutaneous intervention were evaluated at 3, 6, 12, and 24-months of follow-up, and primary patency rates were found to be 92%, 82%, 67%, and 45%, respectively. Conclusion: Our study results suggest that PVOO should not be overlooked in patients with AVF, edema in the extremity, and no loss of fistula functionality. Percutaneous interventions should be considered primarily in the treatment of PVOO.