الفهرس 
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Abstract
T
he main option of renal replacement therapy (RRT) in patients with end stage renal disease (ESRD) is still the hemodialysis (HD).The cornerstone of efficient hemodialysis is the ability to maintain a proper vascular access. The first recommended type of vascular access is the native arteriovenous fistula (AVF) which has a higher patency and lower complication rates compared to other access types such grafts and catheters. Dysfunctional vascular access is a major cause of hospitalization and morbidity in hemodialysis patients.
AVF become dysfunctional and thrombosed because the development of progressive stenosis due to neointimal hyperplasia. Juxta-anastomotic stenosis (lesion in the first 4cm of the vein) was found to be the most common site of stenosis. This can be explained by the fact that the swing segment “the segment of the vein mobilized for arterial anastomosis” may experience turbulent flow and altered shear mechanical stress resulting in stenosis.
In the past, failing or recently failed AVF was abandoned completely and a temporary catheter was inserted and a new access was planned. However, due to the limited number of access sites available for each patient and increasing life expectancy of patients on regular hemodialysis, early detection and treatment of all hemodynamically significant lesions is recommended to prolong the life span of each access as long as possible and to lower the usage of temporary hemodialysis catheters.
The current study involved 30 patients (20 males and 10 females) diagnosed with ESRD presented with dysfunctional AVFs; were treated with conventional balloon angioplasty. Technical success rate reached (90.0%) with only 3 cases failed to be dilated. The overall primary patency rates were (90.0%) at 3 and 6 months.
Based on the results of this study, percutaneous transluminal angioplasty (PTA) for dysfunctional AVF is an excellent treatment option for AV fistula stenosis. As it has the following advantages: It is more durable than the creation of new access or the catheter placement. Percutaneous transluminal angioplasty (PTA) is relatively simple, less invasive, enables us to spare other access sites for further use, helps in minimizing the insertion of central catheters and allowed the patient to start dialysis in the day after intervention.