Effect of venous side branch obliteration for non-maturing arteriovenous fistulae
Matthew Altieri, Robert M. Libera, Michael T. Duan, Ajay K. Dhadwal, MD, Joe T. Huang, MD, Michael A. Curi, MD, Timothy Wu, MD.
Rutgers New Jersey Medical School, Newark, NJ, USA.
OBJECTIVES: There is minimal data to guide decision making when faced with patent venous side branches and non-maturing arteriovenous fistulae. We report on our outcomes of interventions for the obliteration of venous side branches for non-maturing AVF.
METHODS: We retrospectively reviewed 228 dialysis access patients between 2011 and 2015 at an urban academic medical center. In addition to patient demographics and co-morbidities, we obtained data on clinical maturity of the AVF following venous side branch obliteration. Ultrasound data were used to estimate the volume flow through the AVF pre- and post-operatively using standard practices.
RESULTS: Sixteen patients were identified as having undergone venous side branch obliteration during this period for non-maturation at an average of four weeks following initial AVF construction. Of the 16 patients identified, 10 (63%) had radiocephalic AV fistulae while the rest were brachiocephalic AV fistulae. Four patients (25%) had endovascular coil embolization and 12 (75%) had surgical ligation of patent venous side branches. The mean pre-operative volume flow was 2,497 cc/min (range 34-5,911 cc/min) while the mean post-operative volume flow was 5,772 cc/min (range 1,325-12,679 cc/min), representing a more than two-fold increase in mean volume flow following venous side branch obliteration. No access thromboses were noted during this period and all but two became clinically mature and used for hemodialysis following intervention.
CONCLUSIONS: Venous side branch obliteration is a safe and effective treatment for the non-maturing AVF. There are no apparent differences between coil embolization and surgical ligation. While side branch obliteration should be considered in all non-maturing radiocephalic or brachiocephalic AV fistulae, optimal timing, number, and size of branches to be ligated remain unresolved. Further investigation is needed to determine where in the algorithm of treatment for non-maturing AVF venous side branch obliteration should reside.
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