The trans-radial approach for endovascular intervention of the problem arterio-venous fistula: A single-centre case series and systematic review.

INTRODUCTION

The arteriovenous fistula (AVF) is the gold standard access modality for haemodialysis, but due to patient and technical factors, it is prone to stenosis and thrombosis. The trans-radial approach offers multiple unique benefits, but its safety, efficiency and efficacy have not been rigorously studied in the context of the AVF. This study provides a case series of trans-radial AVF procedures, and a systematic review and meta-analysis of existing literature to solidify the role of the trans-radial approach in endovascular AVF surgery.

METHODS

Surgical records were interrogated to identify all trans-radial AVF interventions between 2019 and 2021. The primary endpoints were procedure time and complication rates. The secondary endpoints were primary assisted patency and increase in pre- and post-operative brachial artery blood flow. The systematic review was performed by searching MEDLINE, Embase and CENTRAL from 2000 to 2023.

RESULTS

The case series identified 76 consecutive procedures performed on 49 patients. Mean procedure time was 64 min, and only one complication, a puncture site haematoma, was identified. Mean postoperative AVF flow increase was 342 mL/min ( < 0.001). Primary-assisted patency at 6 and 12 months was 91% and 82% respectively. The systematic review included 16 studies totalling 1163 procedures with a mean MINORS score of 69%. Mean procedure time was 44 min. Complications were rare: procedural failure (1.2%), haematoma (0.90%), radial artery occlusion (0.74%) and pseudoaneurysm (0.12%). Post-procedural flow increased by an average of 274 mL/min. Pooled primary-assisted patency rates at 6 and 12 months were 88% and 77% respectively.

CONCLUSION

The trans-radial approach allows for expedient, safe and durable AVF endovascular surgery, however this technique would benefit from prospective evaluation.