Arteriovenous Fistula Salvage, Durability, and Probable Loss in Renal Patients: A Comprehensive Review of Surgical Techniques

Background: Arteriovenous fistulas (AVFs) remain the gold standard for hemodialysis access in end-stage renal disease (ESRD) patients. However, AVF failure, whether due to thrombosis, stenosis, or maturation failure, poses significant challenges in clinical nephrology and vascular surgery. This review examines the factors influencing AVF salvageability, durability, and probable loss, while evaluating contemporary management strategies. Methods: A systematic analysis of peer-reviewed literature was conducted, focusing on AVF patency rates, surgical revision techniques, endovascular interventions (angioplasty, stenting, thrombolysis), and predictors of long-term functionality. Results: Studies indicate that early detection of AVF dysfunction and prompt intervention significantly enhance salvage rates. Factors such as venous stenosis, inadequate inflow, and patient comorbidities (diabetes, atherosclerosis) critically impact AVF longevity. Endovascular approaches demonstrate high initial success, but surgical revision may offer superior durability in select cases. Conclusion: Optimizing AVF survival requires a multidisciplinary approach, integrating surveillance protocols, timely interventions, and patient-specific risk stratification. Further research is needed to refine predictive models for AVF loss and improve minimally invasive salvage techniques.