Intravascular Arterial Lithotripsy of Medial Calcinosis Causing Low Flow in Dialysis Arteriovenous Fistulae

Distal radiocephalic (DRC) arteriovenous fistula (AVF) maturation can be limited by medial calcification of the inflow artery. Arteriosclerosis potentially restricts vasodilation, preventing adequate flow. Intravascular lithotripsy (IVL) fractures medial calcium and improves vessel compliance. It is unknown whether IVL modifies calcified inflow arteries to achieve adequate flow in AVFs. A retrospective review of IVL of the radial artery (RA) in DRC AVF of 8 patients with maturation arrest secondary to medial calcium was conducted. IVL was performed with concurrent balloon angioplasty of the RA. Technical success was 100%. No adverse events occurred. The mean brachial artery flow rate was 294 mL/min (range, 104-384 mL/min) prior to IVL and 423 mL/min (range, 317-526 mL/min) after IVL (mean increase, 129 mL/min; P = .01). Physiologic maturation was achieved in all patients. Functional maturation occurred in 7 patients. IVL may be employed in the RA of DRC AVFs with maturation arrest due to inadequate arterial flow due to medial calcification of the RA.