الفهرس 
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Abstract
Background: Hemodialysis arteriovenous fistula dysfunction is a big challenging problem. Maintenance of this vascular access is one of corner stones in the care of patients with end stage renal disease. Balloon angioplasty is the first line of salvage of failing arteriovenous fistula (AVF) due to stenosis of venous outflow.
Aim: This prospective study aims at exploring factors affecting the outcome of balloon angioplasty of failing arteriovenous fistula and postulating criteria for success of intervention.
Methods: A convenience sample of patient with failing autogenous arteriovenous fistulae were treated with percutaneous transluminal balloon angioplasty in the period from may 2018 to May 2019. Patients’ age, demographics and comorbidities as well as operative details and technical success were recorded as well as follow up events, and data was compared between patients with successful salvage and those with failed access salvage. The variables, including patients’ demographics, co-morbidities, medications, fistula age, fistula type, site, number of lesions and degree of stenosis and all were analyzed and correlated with primary and secondary patency rates.
Results: The median age of the AVF in this study was 24 months. Among 40 failing AVFs; 16 (40%) were radiocephalic AVFs, 17 (42.5%) were brachiocephalic AVFs and 7 (17.5%) were bracheobasilic AVFs. The most common cause of autogenous access dysfunction was more than 90% stenosis while the most common site of stenosis was juxta-anastomotic (52.5%). Technical and clinical success rates of the intervention were 97.5% and 95% respectively. The primary patency at 1, 3, 6, 9, 12 months were 87.5%, 75%, 55%,, 40% and 32.5% respectively. Univariate cox regression analysis of the variables that potentially affect success and patency of the procedure concluded that three factors were associated with decrease in both primary and secondary patency rates. Hyperlipidemia was associated with decrease primary patency with HR (95% CI) of 2.475 (1.034 – 5.926) and p-value of 0.042 and decrease in secondary patency with HR (95% CI) of 15.848 (1.839 – 136.586) and p-value of 0.012. Insulin intake was associated with decrease in primary patency with HR (95% CI) 3.531 (1.526 – 8.168) and p-value of 0.003 and decrease in secondary patency with HR (95% CI) 13.452 (1.563– 115.748) and p-value of 0.018. the presence of cephalic arch stenosis was also associated with decrease in primary patency with HR (95% CI) 4.950 (1.983 – 12.355) and p-value of 0.001 and decrease in secondary patency with HR (95% CI) 29.856 (3.418 – 260.795) and with p-value = 0.002. Multivariate cox regression analysis was done for the variables with significant association in univariate analysis (table 3) and found that primary patency was reduced by insulin intake with HR (95% CI) of 2.876 (1.200 – 6.889) and p-value of 0.018 and the presence of cephalic arch stenosis HR (95% CI) of 3.050 (1.158 – 8.030) and p value 0.024. And the secondary patency was found to be reduced only by the presence of cephalic arch stenosis HR (95% CI) of 17.794 (1.463 – 220.814) and p value 0.024.
Conclusion: Balloon angioplasty is an important method for salvage of failing hemodialysis arteriovenous fistulae but the primary and secondary patency of the intervention are significantly decreased by the location of stenosis being cephalic arch, and the use of some drugs as insulin. There is no proved association between medical comorbidities and patency.