Endovascular Interventions in Hemodialysis Access Fistulas

Patients with end-stage renal disease (ESRD) depend significantly on maintenance hemodialysis when renal transplantation is not feasible. Nevertheless, the increasing number of patients receiving dialysis via arteriovenous fistulas (AVFs) has led to a notable rise in complications associated with these fistulas. AVFs often face issues such as inadequate maturation, venous stenosis, thrombosis, the formation of venous pseudoaneurysms, and central vein obstruction. Fortunately, various endovascular techniques can effectively manage these complications, including balloon angioplasty, stenting, embolization of early draining collaterals, thrombolysis, and central vein stenting, all intended to prolong the lifespan of the vascular access sites. It is crucial for interventionalists specializing in endovascular procedures to possess a thorough understanding of the different types of AVFs, their possible complications, and the range of endovascular management options available. This article intends to explore the various AVF types, their complications, clinical presentations, ultrasound imaging, and endovascular treatment choices, offering a detailed guide for clinicians involved in treating patients with AVFs.