Venous valve–related occlusion in thrombosed arteriovenous fistulas: outcomes of ultrasound-guided percutaneous transluminal angioplasty

Venous valve–related occlusion (VVRO) is an underdiagnosed cause of arteriovenous fistula (AVF) dysfunction in patients with end-stage renal disease (ESRD). Data regarding the long-term outcomes and prognostic factors associated with ultrasound-guided percutaneous transluminal angioplasty (PTA) for VVRO remain limited. This retrospective cohort study included ESRD patients with VVRO treated by ultrasound-guided PTA following thrombolysis between January 2017 and December 2023. VVRO was diagnosed based on post-thrombolysis duplex ultrasound findings and classified as type I (≤ 3 cm from the anastomosis) or type II (> 3 cm). Patency rates were analyzed using the Kaplan-Meier method. Univariable and multivariable Cox models were used to identify potential factors associated with primary patency. Among 94 patients, 50 had type I VVRO and 44 had type II. The mean age was 56 years, and the median dialysis duration was 35.3 months. Most patients were male (60.6%), and nephritis (55.3%) was the most common cause of ESRD. The overall primary patency rates at 6-month, 1-year, and 3-year were 88.3% (95% confidence interval [CI]: 82.0%–95.0%), 74.5% (95% CI: 66.2%–83.8%), and 51.3% (95% CI: 41.1%–64.2%), respectively. Corresponding secondary patency rates were 92.6% (95% CI: 87.4%–98.0%), 85.1% (95% CI: 78.2%–92.6%), and 76.4% (95% CI: 67.6%–86.3%). No statistically significant difference in patency outcomes was observed between type I and type II VVRO. Body mass index > 20.7 kg/m², post-PTA brachial artery diameter > 6.6 mm and brachial artery flow volume > 1063 mL/min were associated with better primary patency. Ultrasound-guided PTA following thrombolysis may be a feasible treatment option for VVRO, with favorable post-intervention patency outcomes.