Endovascular salvage of early failure of arteriovenous fistula by transradial arterial and retrograde venous fistuloplasty and stenting

Fistula failures are categorized as early or late. Early failure occurs when an arteriovenous fistula (AVF) does not mature sufficiently for use or fails within the first 3 months of its creation. Traditionally, these early failures lead to abandonment of the circuit, but endovascular salvage has proven to be effective in salvaging a significant number. This study describes salvage of AVF with early failure by aggressive fistuloplasty and juxta-anastomotic stenosis (JAS) stenting using the transradial arterial and retrograde venous access technique. This is a retrospective review of a prospectively maintained database of patients who developed early fistula failure between January 2022 and September 2024. Ten patients underwent successful salvage of their failed radiocephalic AVF using this technique and JAS stenting. At 4 weeks post intervention, nine fistulas remained patent and were deemed mature for cannulation. At the 6-month follow-up, 70% of the salvaged fistulas remained patent and functional. Endovascular salvage of early failure of autogenous AVF using the combined transradial arterial and retrograde venous access technique is feasible and safe in highly selected patients and will help to preserve forearm AVF patency.