Salvage of angioaccess after late thrombosis of radiocephalic fistulas for hemodialysis.

A retrospective study of 44 surgical procedures performed in 39 patients with late occlusions of radiocephalic fistulas for hemodialysis is reported. In 6 cases (13.6%) no apparent anatomical cause was found, and a simple thrombectomy was performed as a corrective procedure. Some sort of arterial and/or venous stenosis was present in the other 38 cases. In 11 cases with evidence of mild localized vascular stenosis we performed a thrombectomy and then an endoluminal angioplasty with a balloon catheter and Bakes dilators. In 26 cases, with more severe degrees of stenosis, we made a proximal new fistula in the distal portion of the forearm, bypassing the vascular stenosis, either end-to-end radiocephalic or with interposition of a short segment of PTFE graft. The best results were achieved with the creation of a proximal new fistula, which resulted in almost 50% cumulative patency rates at 2 years, with no immediate failures. We think that an attempt at angioaccess salvage should be made in every case of late thrombosis of radiocephalic fistulas.