Management of autogenous arteriovenous (AV) fistula stenosis part 2

Juxta-anastomotic stenosis most common. Photo courtesy of L. Spergel, MD.

 

Stenosis of the anastomotic area

Surgical treatment is indicated in stenosis of the anastomotic area located in the lower forearm. Alternatively, percutaneous transluminal angioplasty (PTA) is possible although its results are likely to be less long-lasting. Primary interventional treatment is indicated in stenosis of the anastomotic area located in the upper forearm and in the upper arm. Surgery should be considered in cases of early or repeated reccurences of the lessions. Dilatation or surgical revision of anastomotic stenosis in upper arm fistula can cause steal syndrome and access-induced hand ischemia. Careful dilatation up to 5 or 6 mm initially is recommended. Dilatation to >6 mm is rarely indicated

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